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Primary pelvic hydatid cyst

A 19-year-old nulliparous Albanian emigrant presented with constant, lower abdominal pain, radiating caudally. She was on the 23rd day of her cycle. She had two similar episodes in the past 3 months that resolved spontaneously. Clinical examination revealed mild tenderness deep in the right iliac fossa and a nontender, rubbery mass palpable in the right fornix. Laboratory testing was unremarkable. Ultrasonography (US) showed a right adnexal cyst with internal echogenic serpentine-like structures and mild peripheral vascularisation. Computed tomography (CT) scan did not show any fatty or calcification component of the lesion. Magnetic resonance imaging (MRI) revealed a cystic lesion containing proteinaceous fluid and serpentine-like structures. Both the wall and internal structures showed fairly low signal intensity suggesting the diagnosis of hydatid cyst (Figure 1). Abdominal and thoracic imaging was otherwise normal. On laparotomy, a cyst in the right broad ligament, attached to the upper vaginal wall close to the cervix, was removed intact along with a small part of the vaginal wall. Pathological examination confirmed the diagnosis of hydatid cyst. The patient was discharged, receiving 3 cycles of albendazole treatment. A 1-year follow-up did not show any recurrence of disease.