Massive hydatid cysts in the lung and liver of a 4‐year‐old
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Hydatid diseases are not common in children who reside outside the epidemic regions. Asymptomatic infections could persist for years and are often misdiagnosed. A comprehensive review of cyst history and imaging is vital for the early diagnosis of echinococcosis.

Here is a case of 4‐year‐old boy presented with the gradual enlargement of abdominal masses for more than a year, and persistent fever and tachypnea for a few weeks. He was suspected of neuroblastoma due to elevated levels of serum neuron‐specific enolase. However, he had an elevation of absolute eosinophil count of 0.88 × 109/L, which accounted for 5.6% of the total white blood cells. Chest and abdominal enhanced computed tomography (CT) scans showed large, cystic, lobulated structures in the parenchymal portion of the right lung and liver (Figure 1), suggesting hydatid disease. Antibodies against Echinococcus were positive. Praziquantel and albendazole were administered. All cysts were completely removed by an open echinococcectomy without resection of the residual cavities in the lung and liver. Echinococcus granulosa protoscolices were found in the cysts (Figure 2). This patient remained on the anthelmintic treatment with oral albendazole for 6 months after the operation.

Echinococcosis is uncommon in patients with no contact history. This case is expected to alert clinicians to uncommon infections outside the epidemic regions. Delays in treatment may cause devastating outcomes, especially in young children.

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