Graeter Tilmann, Schmidberger Julian, Shi Rong, Kaltenbach Tanja, Barth Thomas F E
Clinical Department of Neuroradiology, Vascular and Interventional Radiology, LKH-University Hospital Graz, Auenbruggerplatz 9, 8036, Graz, Austria.
Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany.
J Med Case Rep. 2025 Jul 16;19(1):349. doi: 10.1186/s13256-025-05298-9.
Alveolar echinococcosis is a rare, potentially fatal parasitosis with the main manifestation site in the liver. Diagnosis already in the initial stage of the disease is important to prevent further exacerbation and possible secondary complications by early targeted therapy. Identifying alveolar echinococcosis lesions on imaging can be difficult, and making the diagnosis can be an interdisciplinary challenge, even in a specialized center.
In a clinically symptom-free 65-year-old white female patient with type 2 diabetes mellitus, an abdominal ultrasonography performed by a colleague in private practice revealed three small hepatic nodules as incidental findings. Further workup focused primarily on the differential diagnosis of hepatic metastatic malignancy. Therefore, a sonographically guided biopsy of the liver lesions was performed under inpatient conditions. During the control sonography routinely performed after the biopsy to exclude postinterventional hemorrhage, an examiner previously uninvolved in the case noticed the typical sonomorphology of initial alveolar echinococcosis lesions in view of the biopsied nodules. The specimens that had been collected peripherally from the target lesion under the primary assumption of metastases histopathologically showed no signs of malignancy and no other landmark findings. Follow-up staining of the biopsies with regard to the recently suspected diagnosis of alveolar echinococcosis, however, remained without a target result as well. Due to the typical sonomorphology, a further biopsy was performed. During rebiopsy, the target lesion was deliberately biopsied centrally to hit the presumed annular lamellar body localized there in alveolar echinococcosis. On the basis of the samples of the second biopsy, the diagnosis of alveolar echinococcosis in the initial stage could be confirmed histopathologically, and the patient was transferred to adequate therapy.
One of the most important differential diagnoses of hepatic alveolar echinococcosis in the initial stage is liver metastases. Knowledge of the typical sonomorphology is essential to avoid misdiagnosis. In addition, proper localization of specimen collection within an alveolar echinococcosis initial lesion is critical to enable histopathologic diagnosis. Imaging and pathology are directly complementary, and imaging can point the way to the correct histopathologic diagnosis on the basis of lesion morphology. For this, knowledge of the specifics of alveolar echinococcosis in imaging and histomorphology is necessary to integratively combine the findings.
肺泡型棘球蚴病是一种罕见的、潜在致命的寄生虫病，主要病变部位在肝脏。在疾病的初始阶段进行诊断对于通过早期靶向治疗预防病情进一步恶化和可能的继发并发症至关重要。在影像学上识别肺泡型棘球蚴病病变可能具有挑战性，即使在专业中心，做出诊断也可能是一项跨学科的挑战。
一名65岁无症状的2型糖尿病白人女性患者，私人诊所的一位同事进行的腹部超声检查偶然发现肝脏有三个小结节。进一步检查主要集中在肝转移性恶性肿瘤的鉴别诊断上。因此，在住院条件下对肝脏病变进行了超声引导下活检。在活检后常规进行的超声检查以排除介入后出血时，一位之前未参与该病例的检查人员鉴于活检的结节注意到了初始肺泡型棘球蚴病病变的典型超声形态。最初在假设为转移瘤的情况下从靶病变周边采集的标本在组织病理学上未显示恶性迹象，也没有其他标志性发现。然而，针对最近怀疑的肺泡型棘球蚴病诊断对活检进行的后续染色也未得到靶向结果。由于典型的超声形态，进行了再次活检。在再次活检时，故意对靶病变进行中央活检，以取到肺泡型棘球蚴病中假定位于此处的环形板层体。根据第二次活检的样本，组织病理学上确诊为初始阶段的肺泡型棘球蚴病，患者被转至适当治疗。
肝脏肺泡型棘球蚴病初始阶段最重要的鉴别诊断之一是肝转移瘤。了解典型的超声形态对于避免误诊至关重要。此外，在肺泡型棘球蚴病初始病变内正确定位标本采集对于实现组织病理学诊断至关重要。影像学和病理学直接互补，影像学可根据病变形态为正确的组织病理学诊断指明方向。为此，有必要了解肺泡型棘球蚴病在影像学和组织形态学方面的特点，以便综合分析各项检查结果。
