1526
THE RED SECTION
nature publishing group
Images of the Month Am J Gastroenterol 2014;109:1526; doi:10.1038/ajg.2014.311
Hepatic alveolar echinococcosis. A 58-year-old woman was admitted with fever, fatigue, loss of appetite, and weight loss of 4 weeks. (Left) Mass lesions with rim-like, very intense fluoro-2-deoxy-d-glucose (FDG) uptake (maximum standardized uptake value (SUVmax) = 18.9) and central areas of photopenias corresponding to calcified areas were seen on (a) axial positron emission tomography (PET), (b) axial computed tomography (CT), (c) axial fused PET/ CT, and (d) maximum intensity projection PET images. The patient reported that eight years previously she had been diagnosed with hepatic alveolar hydatid disease and received albendazole therapy. After the lesions diminished and became calcified and the serology became negative, albendazole was discontinued. Three months later, she was admitted with the symptoms described above. Three days after albendazole therapy was reinstated, her body temperature returned to normal; the other symptoms improved in one week. (Right) At one-year follow-up, PET/CT showed improved lesions with less intense FDG uptake (SUVmax= 10.0) on (a) axial PET, (b) axial CT, (c) axial fused PET/CT, and (d) maximum-intensity-projection PET images. (Submitted by Resat Ozaras, Betul Vatankulu, and Khalis Mustafayev, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.)
Hydatid disease. An 83-year-old woman with a history of echinococcal cyst—diagnosed in 2006 in Bangladesh—presented with abdominal pain. Magnetic resonance imaging/magnetic resonance cholangiopancreatography revealed a large hepatic cyst with internal septations comprising most of segments 7 and 8 of the liver and measuring 9.3 × 9.5 × 8.8 cm (anteroposterior × transverse × craniocaudal). An additional hepatic cyst was identified, with internal heterogeneous material and septations within segments 2 and 3 of the liver, extending inferiorly to the midabdomen at the level of the iliac bifurcation, and measuring 13.0 × 15.8 × 18.3 cm. The findings were consistent with hydatid disease, and the patient was treated with albendazole. Because the lesions were deemed not amenable to PAIR (puncture, aspiration, injection, and reaspiration), the patient was subsequently taken to the operating room for surgical enucleation of the lesions. (Submitted by Gaya Spolverato and Timothy M. Pawlik, Johns Hopkins Hospital, Baltimore, Maryland.)
The American Journal of GASTROENTEROLOGY
VOLUME 109 | OCTOBER 2014 www.amjgastro.com
THE RED SECTION
nature publishing group
Images of the Month Am J Gastroenterol 2014;109:1526; doi:10.1038/ajg.2014.311
Hepatic alveolar echinococcosis. A 58-year-old woman was admitted with fever, fatigue, loss of appetite, and weight loss of 4 weeks. (Left) Mass lesions with rim-like, very intense fluoro-2-deoxy-d-glucose (FDG) uptake (maximum standardized uptake value (SUVmax) = 18.9) and central areas of photopenias corresponding to calcified areas were seen on (a) axial positron emission tomography (PET), (b) axial computed tomography (CT), (c) axial fused PET/ CT, and (d) maximum intensity projection PET images. The patient reported that eight years previously she had been diagnosed with hepatic alveolar hydatid disease and received albendazole therapy. After the lesions diminished and became calcified and the serology became negative, albendazole was discontinued. Three months later, she was admitted with the symptoms described above. Three days after albendazole therapy was reinstated, her body temperature returned to normal; the other symptoms improved in one week. (Right) At one-year follow-up, PET/CT showed improved lesions with less intense FDG uptake (SUVmax= 10.0) on (a) axial PET, (b) axial CT, (c) axial fused PET/CT, and (d) maximum-intensity-projection PET images. (Submitted by Resat Ozaras, Betul Vatankulu, and Khalis Mustafayev, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey.)
Hydatid disease. An 83-year-old woman with a history of echinococcal cyst—diagnosed in 2006 in Bangladesh—presented with abdominal pain. Magnetic resonance imaging/magnetic resonance cholangiopancreatography revealed a large hepatic cyst with internal septations comprising most of segments 7 and 8 of the liver and measuring 9.3 × 9.5 × 8.8 cm (anteroposterior × transverse × craniocaudal). An additional hepatic cyst was identified, with internal heterogeneous material and septations within segments 2 and 3 of the liver, extending inferiorly to the midabdomen at the level of the iliac bifurcation, and measuring 13.0 × 15.8 × 18.3 cm. The findings were consistent with hydatid disease, and the patient was treated with albendazole. Because the lesions were deemed not amenable to PAIR (puncture, aspiration, injection, and reaspiration), the patient was subsequently taken to the operating room for surgical enucleation of the lesions. (Submitted by Gaya Spolverato and Timothy M. Pawlik, Johns Hopkins Hospital, Baltimore, Maryland.)
The American Journal of GASTROENTEROLOGY
VOLUME 109 | OCTOBER 2014 www.amjgastro.com
