Question:

Which of the following statement about hydatid disease is false?
1. Humans are intermediate host.
2. Low-signal-intensity rim on T2 weighted MRI images is more commonly seen in muscular hydatid disease.
3. `Floating water lily sign` on imaging is an indication of ruptured hydatid disease.
4. `Curvilinear calcification` of the cyst is often seen in hydatid disease.
5. Surgical therapy is not an option in soft tissue hydatid disease.





Answer:

The correct answer for the question "Which of the following statement about hydatid disease is false?" is:

5. Surgical therapy is not an option in soft tissue hydatid disease.



Explanation
"[Low-signal-intensity rim is often evident on T2-weighted MR images which are not a common finding in hydatid cysts located elsewhere in the body. The endocyst may detach from the pericyst causing `floating membranes` inside the cavity, which is highly specific for hydatid disease. Complete detachment has been referred to as the "floating water lily sign". Conservative therapeutic approach is often adopted in soft tissue lesions mainly due to slow growth secondary to muscle contractility and presence of lactic acid. The surgical treatment options include excision and simple drainage.]"

1. Humans are intermediate host. [Dogs, foxes & canines are the definitive host while sheep, goat, rodents & humans are intermediate host. Humans are also considered to be accidental hosts].

2. Low-signal-intensity rim on T2 weighted MRI images is more commonly seen in muscular hydatid disease [Low-signal-intensity rim on T2-weighted MR images has been described as characteristic sign to suggest hydatid etiology rather than non-parasitic origin in the liver and lungs. This finding represents the parasitic membranes and pericyst. Low-signal-intensity rim on T2-weighted MR images is more frequently seen in musculo-skeletal locations as compared to other locations].

3."Floating water lily sign" on imaging is an indication of ruptured hydatid disease. [when the endocyst detaches from pericyst and there is loss of intracystic pressure, the ruptured cyst gives an appearance of floating water lily both on USG & MRI].

4. `Curvilinear calcification` of the cyst is often seen in hydatid disease [Calcification of the wall is seen in late stages which is often curvilinear in shape].

5. Surgical therapy is not an option in soft tissue hydatid disease. [surgical excision or drainage is another option in treatment of hydatid disease apart from conservative management].



From the manuscript:
Imaging of ruptured endocyst in an isolated intramuscular hydatid cyst - The Scroll appearance
Radiology Case. 2012 Aug; 6(8):17-21


This article belongs to the MSK section.




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From the manuscript

Imaging of ruptured endocyst in an isolated intramuscular hydatid cyst - The Scroll appearance

Free full text article: Imaging of ruptured endocyst in an isolated intramuscular hydatid cyst - The Scroll appearance

Abstract
The present article reports a case of a 21 years male that was diagnosed to have isolated intramuscular hydatid cyst of the biceps brachii on Ultrasound and MRI. The `Scroll appearance` of the ruptured endocyst in this case is likely to be an intervening transient stage in evolution of the disease and also indicates recent rupture of the endocyst.






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