18/03/2026
A 3-year-old male Dalmatian presented with peritoneal effusion. More than 1 L of brown-reddish abdominal fluid was drained prior to CT. Ultrasound revealed multiple cystic hepatic lesions, prompting further evaluation with CT.👇🏼
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
Imaging demonstrated severe hepatomegaly with multifocal cystic masses of variable size. They are characterized by irregular and variably thick walls, internal septation, and centrally hypoattenuating contents without contrast enhancement. Moderate ascites and mild portal lymphadenomegaly is identifed.
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
🤔 The imaging findings are highly suggestive of a parasitic infection with Echinococcus multilocularis (hepatic alveolar echinococcosis).
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
📚 CT typically reveals the well-marginated, canine hepatic AE lesions with
- walls of variable thickness
- irregular inner margins
- soft-tissue-attenuating and contrast enhancing septae
- absence of central contrast enhancement
- feathery wall mineralization in more advanced stages
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
📑 Recent studies suggest two morphologic patterns:
1. multiple small thin-walled lesions (may represent early lesions)
2. larger thick-walled cavitary masses (probably representing more advanced stages)
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
The liver is the most commonly affected organ, although other organs such as the lungs, brain, kidneys, or bones can also be involved.
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
💭 Clinical Take-Home
When you see multifocal cavitary liver lesions in dogs - especially in endemic regions - always include alveolar echinococcosis in your differential diagnoses. 🧐 This disease carries zoonotic potential. The diagnosis can be confirmed via histopathology or DNA-PCR of cyst fluid.
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
Last but not least other differential diagnoses include hepatobiliary cysts, abscesses, nodular hyperplastic lesions, and cystic hepatic neoplasms.
⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
Stay curious - and have a great day 🫡😊
