39 year female patient with acute on chronic abdominal pain

1. Axial CECT of upper abdomen shows a large hypodense peripherally enhancing lesion involving the liver that shows air foci and suspicious thin internal membranes – at this point of evaluation, differentials would include liver abscess and infected hydatid cyst. Going further below in the pelvis(2 and 3), multiple hypodense peripherally enhancing lesions with peripherally arranged daughter cysts are noted in the peritoneal cavity. Coronal image(4) shows the involvement of liver and peritoneal cavity. Diagnosis is confirmed to be liver and peritoneal hydatid cysts. At this point, we should also look for complications of any. Axial CECT of upper abdomen(5) shows subcapsular rupture of one of the liver hydatid cysts and axial CECT(6) shows mild right pleural effusion that might suggest pleural rupture. Patient needs urgent intervention/surgery for such findings and the findings should be conveyed immediately to the treating doctor/unit.