LAUSR

An 85-year-old woman was admitted to our emergency department with complaints of upper right abdominal quadrant pain, skin redness, and swelling on the right side of the abdomen (Figure 1). The medical record revealed that the patient had been diagnosed with hydatid disease based on computed tomography findings and detected with anti-Echinococcus IgG antibodies approximately 1 year before (Figure 2A) and treated with albendazole. Laboratory tests showed elevated C-reactive protein levels (117 mg/L) and white blood cell count (17.7 109/L), and abdominal ultrasonography revealed an unshaped collection in the inferior segment of the right liver lobe spreading to the lateral abdominal wall, with fistulization to the skin. Contrast-enhanced magnetic resonance imaging (MRI) showed a ruptured hydatid cyst (HC) consistent with a previous liver HC lesion in liver segments VI and VII. On gadolinium-enhanced MRI, the ruptured HC appearance was peripherally enhanced, consistent with abscess formation, and accompanying soft tissue infection and fistulization were found (Figure 2B). A drainage catheter was placed in the patient under general anesthesia, and medical treatment was started.