Echinococcosis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]


Cystic echinococcosis must be differentiated from other diseases presenting with right sided abdominal pain such as pyogenic liver abscess and amoebic liver abscess and fungal liver abscess.

Differential Diagnosis

Echinococcal cyst must be differentiated from other diseases presenting with hepatic abscess and right sided abdominal pain such as:

Disease Causes Symptoms Lab Findings Imaging Findings Other Findings
Fever Pain Cough Hepatomegaly Jaundice Weight loss Diarrhea

or Dysentry

Nausea and


Abdominal pain

(right upper quadrant pain)

Pleuritic pain
Echinococcal (hydatid) cyst Echinococcus granulosus

(Obstructive jaundice)

Histology: Hydatid cyst with three layers:
  • The outer pericyst: Corresponds with compressed and fibrosed liver tissue
  • The endocyst: An inner germinal layer
  • The ectocyst: A thin, translucent interleaved membrane
  • Blood or liquid from the ruptured cyst may be coughed up
  • Pruritis
Amoebic liver abscess Entamoeba histolytica ✔✔✔ ✔✔✔ ✔/✘ ✔✔/✘

(late stages)

(late stages)


  • Homogenous hypoechoic areas that can be single or multiple with round edges
  • Round or oval in shape with variable size (around 2-6 cm in diameter)
  • An incomplete rim of edema
  • Respond well to chemotherapy and rarely require drainage
  • Marked male predominance
  • More common in developing countries
  • Sero-positive
  • Right lobe is more frequently involved
Pyogenic liver abscess Bacteria ✔✔ ✔✔ ✔/✘ ✔✔✔

(acute loss)

Pale/dark stool


  • CT scan shows cluster sign
  • Aggregation of multiple low attenuation liver lesions in a localized area to form a solitary larger abscess cavity
  • Abnormal pulmonary findings
  • Diabetes mellitus increases the risk
  • Medical-surgical approach is indicated
  • More common in developed countries
  • Culture positive and sero-negative
  • Both lobes are commonly involved
Fungal liver abscess Candida species
Aspergillus species
✔/✘ CT and Us findings with four patterns of presentation:
  • Wheel-within-a-wheel pattern
  • Bull’s-eye configuration pattern
  • Uniformly hypoechoic nodule
  • Echogenic foci with variable degrees of posterior acoustic shadowing

(hepatocellular carcinoma/metastasis)


✔✔ Pale/Chalky stool ✔✔ Other symptoms:
Morphology Septations Wall character Cyst contents
Hydatid cyst Cyst with in cyst - Thick, uniform


Daughter cysts
Congenital cyst Single or multiple cysts +/- Thin Low density
Cystedenoma Single or multiple cysts +/- Mural nodules Low density


  1. Accessed on February 22, 2017
  2. Lublin M, Bartlett DL, Danforth DN, Kauffman H, Gallin JI, Malech HL; et al. (2002). "Hepatic abscess in patients with chronic granulomatous disease". Ann Surg. 235 (3): 383–91. PMC 1422444. PMID 11882760.

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