Hepatic hydatid disease presenting as secondary Budd-Chiari syndrome

To cite: Neelakantan S, Babu AAS, Anandarajan R, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016217118 DESCRIPTION A 51-year-old man presented with a history of vague abdominal pain and progressively increasing abdominal distension. Abdominal examination revealed hepatomegaly with a firm nodular liver palpable below the costal margin with mild tenderness in the right hypochondriac region. General examination revealed no pedal oedema, ascites or jaundice. No significant history or drug history was elicited. Imaging work up included a transabdominal ultrasound scan performed elsewhere which showed a multilocular cystic lesion in the right lobe of the liver with coarsened hepatic echotexture and surface nodularity. Serology was positive for hydatid disease. Contrast-enhanced CT scan (CECT) of the abdomen performed at our centre revealed a large multilocular cystic lesion in the right lobe of the liver with enhancing walls and daughter cysts within (figure 1), with extrahepatic extension into the gastrohepatic ligament and transdiaphragmatic extension into the middle mediastinum through the bare area of the liver (figure 2). The lesion was noted to cause extrinsic compression of the retrohepatic inferior vena cava (IVC) so that the right and middle hepatic veins were not visible (figures 3 and 4). Volume redistribution, surface nodularity and altered parenchymal enhancement of the liver were also noted (figure 5). There was also omental fat stranding with mild ascites (figures 4 and 5). Based on the clinical presentation and imaging findings, a diagnosis of hepatic hydatid cyst causing secondary Budd-Chiari syndrome was made. The patient was advised surgery, but refused further treatment due to financial constraints. The patient was started on long-term albendazole and anticoagulation, and was advised follow-up after 3 months. On 3-month follow-up, he had significant relief of symptoms. Hydatid disease, endemic to the tropics is caused by multiple species of the parasite Echinococcus, most commonly by E. granulosus. Budd-Chiari