Cystic echinococcosis, a rare differential diagnosis of cystic pelvic masses

Introduction

As a second-line imaging modality for leiomyomas (syn. fibroids) to sonography in clinical routine, MRI offers the advantages of a large field-of-view, multiplanarity and excellent soft-tissue contrast. MRI can accurately aid therapeutical planning (surgical and interventional) and helps in the detection of differential diagnoses (e.g. malignancy, inflammation). The basic MRI imaging protocol for leiomyomas, recommended by the European Society of Urogenital Radiology (ESUR), includes an axial T1W sequence as well as sagittal and axial T2W sequences; if necessary, supplemented by dynamic contrast sequences and optional diffusion-weighted images (DWI) in the case of indeterminate adnexal masses, rapidly growing uterine masses or T2W-hyperintense leiomyomas (Kubik-Huch RA et al. Eur Radiol 2018; 28: 3125–3137). Whereas leiomyomas without degeneration or variant histologic subtype can be diagnosed with confidence on MRI, the various types of degeneration (hyaline, cystic, myxoid, red/carneous, calcific, post-embolization) can significantly alter imaging appearance with overlapping features of malignant or infectious disease. We report a case of extrahepatic, pelvic cystic echinococcosis in contact with the uterus, mimicking degenerated leiomyomas.

Publication History

Received: 11 May 2023

Accepted after revision: 13 November 2023

Article published online:
05 December 2023