A 46-year-old woman, who had lived in rural Australia as a child, presented with abdominal distension, jaundice and cachexia. Abdominal computed tomography showed extensive cystic disease of the liver, peritoneum, ovaries and uterus; well circumscribed coarsely calcified cysts were visible in the abdomen and pelvis (Figure A). Results of hydatid serological testing were consistent with Echinococcus granulosus infection (indirect haemagglutination titre, 256). The patient was managed with preoperative albendazole therapy, extensive surgical excision, hypertonic saline irrigation, and decompression of the ruptured left hepatic duct with a T-tube. Microscopy of cystic fluid aspirated during surgery showed viable evaginating protoscolices (Figure B; original magnification, × 400). Long-term suppressive therapy — albendazole 400 mg twice daily plus praziquantel 40 mg/kg twice weekly — was initiated with good effect.
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