Fig. 3

Fifty-eight years old male patient presented with abdominal fullness. Imaging findings: grey scale B-mode Ultrasonography (a): normal sized liver with a well-defined anechoic focal lesion with septations inside seen occupying most of the right liver lobe measuring 11.1 × 9.6 cm with 2.3 cm depth from the skin. ϖ Color-coded shear wave sono-elastography: measurements are taken in the septations showed yellow green color (b, c, d), while the liver parenchyma showed dark blue color (e, f, g). ϖ Shear wave sono-elastography stiffness values of the focal lesion: E1 = 14.31 kPa (b), E2 = 13.57 kPa (c), and E3 = 13.42 kPa (d). Calculated average stiffness value of the lesion = 13.76 kPa. ϖ Shear wave sono-elastography stiffness values of the parenchyma: E1 = 5.43 kPa (e), E2 = 5.28 kPa (f), and E3 = 5.52 kPa (g). Calculated average stiffness value of the parenchyma = 5.41 kPa. Lesion/parenchyma stiffness ratio = 2.54. ϖ Axial contrast enhanced CT study (non-contrast (h), post-contrast (i)): a large well-defined non-enhancing multilocular cystic lesion with multiple septae and daughter cysts. It is seen occupying most of the right liver lobe. ϖ Contrast enhanced MRI study (non-contrast axial T1 (j), post-contrast fat sat T1 WI (k), and non-contrast coronal T2 WI (l)): a large well-defined non-enhancing multilocular cystic lesion with multiple septae and daughter cysts. It is seen occupying most of the right liver lobe. It displays low SI on T1 WI, high SI on T2 WI images, and shows no enhancement on post-contrast T1WI. ϖ Diagnosis: hydatid cyst