Intrathoracic Extrapulmonary Hydatid Disease: Radiologic Manifestations Dilek Emlik, MD, Demet Kiresi, MD, Guven Sadi Sunam, MD, Ali Sami Kivrak, MD,

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Intrathoracic Extrapulmonary Hydatid Disease: Radiologic Manifestations Dilek Emlik, MD, Demet Kiresi, MD, Guven Sadi Sunam, MD, Ali Sami Kivrak, MD, Sami Ceran, MD, Kemal Odev, MD Canadian Association of Radiologists Journal Volume 61, Issue 3, Pages 170-176 (June 2010) DOI: 10.1016/j.carj.2009.12.002 Copyright © 2010 Terms and Conditions

Figure 1 Posterior mediastinal hydatid cyst in 25-year-old woman with chest pain. (A) Chest radiograph shows a large, well-defined mediastinal mass (arrows). (B) Enhanced computed tomography shows a cystic mass with uniform attenuation and a thick wall. (C) Coronal T2-weighted magnetic resonance image shows a homogenous signal intensity of the cyst and a peripheral rim, demonstrating low signal intensity and representing the capsule (arrow). Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions

Figure 2 Mediastinal multilocular (type 2) hydatid cyst in a 50-year-old woman with precordial and chest pain. (A) Enhanced computed tomography shows multilocular hydatid cyst. (B) T2-weighted magnetic resonance image shows multiple high signal intensity daughter cysts with a low signal intensity capsule (arrows). Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions

Figure 3 Primary calcified anterior mediastinal hydatid cyst in an asymptomatic 60-year-old man. Nonenhanced computed tomography shows a cyst with an extensively calcified wall. Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions

Figure 4 Primary pericardial multilocular (type 2) hydatid cyst in a 45-year-old woman with severe chest and precordial pain, and tiredness. (A) Turbo FLASH sequence-proton density weighted axial image (TR/TE;770/31) shows a multilocular high signal intensity of the pericardial cysts with a low signal intensity capsule. (B) On Turbo FLASH sequence, T2-weighted images (TR/TE:64.5/1.8), the visualization of the daughter cysts are best demonstrated. Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions

Figure 5 Primary hydatid cyst (type 1) in the pleural fissure in a 20-year-old woman with a history of recurrent pneumonia attacks. (A, B) Enhanced computed tomographic images show a hypodense lobulated mass in the left upper lung parenchyma on the mediastinal and lung window settings. (C) Axial T2-weighted magnetic resonance image shows a high signal intensity cyst with a low signal intensity capsule in the left major fissure (arrows). Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions

Figure 6 Primary ruptured hydatid cyst in the pleural space in a 22-year-old woman, who has 8-week gestation, complaining of suddenly violent chest pain, coughing attacks, nausea, and vomiting. She had no parenchymal lung or other organ involvement. Coronal magnetic resonance imaging (Turbo FLASH; TR/TE: 5.0./2.5) shows a pleural hydatid cyst, demonstrating daughter cysts and the water-lily sign (arrows), which represents a detached membrane (type 3). Detached germinal membranes are clearly seen as hypointense structures. A pleural effusion is also seen. Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions

Figure 7 Posterior mediastinal hydatid cysts (HC) by transdiaphragmatic extension from the abdomen in a 25-year-old woman with a history of liver HC surgery 4 years earlier. (A) Enhanced computed tomography shows a large cystic mass that contains multiple low-attenuation daughter cysts (curved arrows indicate the routes of the HCs extension from the abdomen to the thoracic cavity via the esophageal hiatus and the bare area of the liver). (B) Sagittal and (C) coronal T2-weighted magnetic resonance images show a huge cystic mass that extends to the posterior mediastinum through the diaphragm from the abdomen. Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions

Figure 8 Primary diaphragmatic hydatid cyst in a 34-year-old woman with abdominal pain. Coronal (A) and sagittal (B) reformatted computed tomography scans show an hydatid cyst in the right diaphragm. Canadian Association of Radiologists Journal 2010 61, 170-176DOI: (10.1016/j.carj.2009.12.002) Copyright © 2010 Terms and Conditions