Photoclinic Diagnosis: Primary Hydatid Disease of the Pancreas

A45-year-old housewife was referred to our center with a two-week history of moderate to severe pain and fullness of the epigastric and left upper quadrant area. She had no history of fever, jaundice, abdominal trauma, weight loss, or other symptoms. She gave a history of epigastric fullness and dyspepsia of one year duration, for which she was taking ranitidine on demand. Physical examination was normal except for the presence of a large, smooth, and nontender mass in the epigastric area extending to the left upper quadrant. Paraclinical investigations, including a complete blood count, liver and kidney function tests, serum lipase, blood chemistry, CA19-9, CEA, urinalysis, and stool examination for ova, parasites, and occult blood were reported normal except for an erythrocyte sedimentation rate of 50 mm after the first hour and a serum amylase of 300 IU/dL. Chest X-ray was normal. Abdominal ultrasonography revealed a large cystic mass measuring about 15 cm in diameter compatible with a large pseudocyst of the pancreas. An abdominal computerized tomography (CT) scan was taken.