|Year : 2017 | Volume
| Issue : 1 | Page : 129-130
Water lily sign and serpent sign in pulmonary hydatid cystic disease
Department of Pulmonary Medicine, ESIC Post Graduate Institute of Medical Science and Research, New Delhi, India
|Date of Web Publication||16-Jun-2017|
29 A, Ramesh Nagar, New Delhi - 110 015
Source of Support: None, Conflict of Interest: None
The teaching image depicts sections of CT chest showing water lily sign and serpent sign. In the diagnosis of pulmonary hydatid disease, these signs are pathognomonic, these must be corroborated clinically, and early interventions should be done to avoid rupture of cysts leading to complications.
Keywords: Hydatid cyst, pulmonary hydatid cyst, serpent sign, water lily sign
|How to cite this article:|
Ranjan A. Water lily sign and serpent sign in pulmonary hydatid cystic disease. Arch Med Health Sci 2017;5:129-30
A male patient aged 43 years presented with complaints of cough, expectoration, recurrent haemoptysisand weight loss. Amongst his diagnostic workup, the chest computed tomography (CT) showed classical features of bilateral pulmonary hydatid cysts. Surgical intervention was done and patient cured. Pulmonary involvement in the hydatid disease is common as lung is the second most common site for hematogenous spread, but in children, lung is the most common site. Liver and lungs simultaneously involved in about 6% of cases. Cysts generally located in lower lobes (60% cases) and can be multiple (30% cases) and bilateral (20% cases)., Hydatid disease is a parasitic infestation of humans caused by Echinococcus granulosus and multilocularis, which produce cystic lesions in any part of body. Hydatid cyst consists of three layers – the outermost pericyst made of fibrous tissue represents the response of the host to the parasite, middle layer of laminated membrane (ectocyst), and innermost layer of germinal epithelium (endocyst) which secretes the hydatid fluid internally and laminated membrane externally producing new generation of parasites. Sometimes, collapsed membranes of cyst may be seen floating on the surface of the cyst also known as the “water lily sign” [Figure 1].
|Figure 1: Collapsed membranes of cyst floating on the surface of the cyst also known as the “water lily sign”|
Click here to view
Detachment of the endocyst with its collapse results into serpent sign [Figure 2]. The rupture may be related to decreasing intracystic pressure, degeneration, host response, trauma, or response to therapy.
|Figure 2: Collapsed membranes of cyst floating on dependent portion of the cyst known as “serpent sign”|
Click here to view
Uncomplicated cysts appear as round, oval, or polycyclic well-defined mass lesions. In conclusion, CT is the imaging modality of choice which can provide an accurate diagnosis. There should be interdisciplinary awareness of the typical and atypical imaging features of the disease.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Beggs I. The radiology of hydatid disease. AJR Am J Roentgenol 1985;145:639-48.
Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS. Hydatid disease: Radiologic and pathologic features and complications. Radiographics 2000;20:795-817
Pomelov VS, Karimov ShI, Nishanov KhT. Surgical tactics in associated echinococcosis of the liver and lung. Khirurgiia (Mosk) 1991;11:69-74.
Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A. Hydatid disease from head to toe. Radiographics 2003;23:475-94; quiz 536-7.
Aytac A, Yurdakul Y, Ikizler C, Olga R, Saylam A. Pulmonary hydatid disease: Report of 100 patients. Ann Thorac Surg 1977;23:145-51.
[Figure 1], [Figure 2]