Picture Quiz: Circular shadows in the lung field
A 43 year old farmer, a chronic smoker and an alcoholic, was admitted with blood tinged sputum, dry hacking cough, heaviness in the chest, and breathlessness for more than three years. He had no history of fever, night sweats, weight loss, or anorexia. Upon examination he had 5 cm, non-tender, smooth surfaced, enlarged liver and dullness in the right and left apical and mid-zone of both lungs. The base of the right side was also dull on percussion with bronchial breathing. After admission, all investigations, including haemogram, blood sugar, serum electrolytes, and liver and kidney functions were normal.
E multilocularis is the second most common species. The fox is its definitive host, and microtine rodents are its intermediate host. The primary localisation of alveolar cysts is in the liver, where they may extend locally or metastasise to other organs. The larval mass has poorly defined borders and behaves like a