Echinococcosis Hydatid Cyst Clinical Presentation

Updated: Nov 15, 2023
  • Author: Enrico Brunetti, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Months or years may pass before an individual exhibits any signs or symptoms of infection with the cystic larval stages.

During the natural course of infection, the fate of E granulosus cysts is variable. Some cysts may grow to a certain size and then persist without noticeable change for many years. Other cysts may rupture spontaneously or collapse and completely disappear. [20, 21, 22]

Spontaneous or traumatic cyst rupture and spillage of viable parasitic tissue during interventional procedures may result in secondary CE. Cysts may rupture into the peritoneal or pleural cavity, the pericardium, the bile ducts, the gastrointestinal tract, or even blood vessels, leading to extraordinary manifestations and severe complications. [23, 24]

Usually, cysts do not induce clinical symptoms before they have reached a size sufficient to exert pressure on adjacent organs. After a variable incubation period, infections may become symptomatic if cysts are growing and exerting pressure on adjacent tissue and inducing other pathologic findings. [25]  Sudden symptomatology usually is due to spontaneous or traumatic cyst rupture.



The presentation of human echinococcosis is protean. [25, 26, 27, 28]  Patients come to the clinician's attention for different reasons, such as when a large cyst has some mechanical effect on organ function or rupture of a cyst causes acute hypersensitivity reactions. The cyst may also be discovered accidentally during radiographic examination, body scanning, surgery, or for other clinical reasons. [14, 25]

Common chief symptoms are upper abdominal discomfort and pain, poor appetite, and a self-diagnosed mass in the abdomen. Physical findings are hepatomegaly, a palpable mass if on the surface of the liver or other organs, and abdominal distention. If cysts in the lung rupture into the bronchi, intense cough may develop, followed by vomiting of hydatid material and cystic membranes. [25, 26, 27, 28]

Liver findings may include the following [3, 12] :

  • Hepatomegaly
  • Jaundice
  • Biliary colic–like symptoms Cholangitis
  • Pancreatitis Liver abscess
  • Portal hypertension Ascites
  • Inferior vena cava compression or thrombosis Budd-Chiari syndrome
  • Cyst rupture, peritoneal spread, and peritonitis Hemobilia
  • Biliary fistula to skin, bronchial system, or gastrointestinal tract Lung findings may include the following:
  • Tumor of chest Chest pain
  • Chronic cough, expectoration, and dyspnea
  • Pneumothorax Eosinophilic pneumonitis Pleural effusion
  • Parasitic lung embolism
  • Hemoptysis Biliptysis

Heart findings may include the following:

  • Tumor
  • Pericardial effusion Embolism
  • Breast masses may be found (must be differentiated from neoplasms). Spine masses with neurologic symptoms may be found.
  • Brain masses with neurologic symptoms may be found. [29, 30, 31, 32, 33]


Several complications are possible depending on cyst size, location, and relation with other organs. Abdominal cysts may rupture, both spontaneously or as a consequence of percutaneous treatment or surgical intervention, although iatrogenic rupture is a rare instance. [34]  When an echinococcal cysts rupture, protoscoleces have the chance to spread in the peritoneum or pleura and cause secondary CE, whereas if the spread occurs in a blood vessel this can cause hematogenous spread of the disease (secondary CE) or thromboembolism. Rupture in the bronchi manifests with the presence of vomica (ie, the expulsion of cyst fragments with cough). [26, 27, 28, 34]