Hydatid liver disease and water lily sign.
A 55-year-old lady presented with pain abdomen for two months. She had protuberant abdomen with tender hepatomegaly. Ultrasonography of abdomen revealed 164x102x129 mm cystic lesion with thin-walled internal septae in the right lobe of the liver with a detached laminated membrane or floating membrane and daughter cysts suggestive of active hydatid cyst. She was managed with tablet albendazole for three months and ultrasonography-guided percutaneous puncture, aspiration, injection of scolicidal agents and re-aspiration. One-year later on follow up, she is asymptomatic. Hydatid cysts disease is a zoonosis caused by the larva of Echinococcus. Diagnostic features on ultrasonography include 'Water Lilly sign' and 'Snowflake sign.' In suspected cases, hydatid serology by ELISA confirms the diagnosis. Treatment with Benzimidazole compounds (albendazole or mebendazole), can be curative in at least one-third of cases. Repeated ultrasonography-guided percutaneous drainage [puncture, aspiration, injection of scolicidal agents and re-aspiration (PAIR)] is a useful adjunct.