Microscopic Image of the Protoscolex of Echinococcus granulosus on the “Hydatid Sand”

An 8-year-old child originally from Morocco spent 1 month in Spain before complaining of abdominal pain for the previous 24 hours. There was no fever, vomiting, or diarrhea. He had lived in a rural area with dogs and sheep. Physical examination detected a mass in upper-right abdominal area. Chest X-ray showed right hemidiaphragmatic elevation. Ultrasonography showed a hypoechoic cyst mass of 12.5 × 10.5 × 8.5 cm without septum or calcifications that was a type CE1 according to the World Health Organization standardized classification. 1, 2 Computed tomography ( Figure 1 ) and magnetic resonance imaging confirmed the diagnosis of hepatic hydatid cyst. Invasion into the biliary tree bile ducts, portal vein, or hepatic vein was not seen. IgE-specific serology for Echinococcus granulosus was positive (18.3 kUI/L). Serology for Entamoeba histolytica was negative. Aspartate and alanine amino transferase levels were increased (145 U/L and 151 U/L, respectively). Treatment with albendazole was initiated, and cystectomy was performed on the 18th day after admission. Gross examination showed hydatid sand; the