Pulsatilehydatid Cyst in Left Lobe of Liver- An Uncommon Phenomenon

Introduction: Hydatid cysts of the liver, caused by the parasite Echinococcus granulosus, typically present as slow-growing, often asymptomatic, fluid-filled sacs in the liver (50-70% of cases). Case reports show patients often present with right upper quadrant abdominal pain, nausea, and fever due to compression or infection. Diagnosis is confirmed via CT or ultrasound, and treatment usually involves albendazole therapy and surgical intervention (e.g., pericystectomy or cystectomy). Case Report:A 35-year-old female, not a known case of any chronic illness presented with complaints of a mass in epigastric area for last three months. It was insidious in onset and gradually progressive and was associated with a localized, dull aching pain at the site of the mass for last two weeks which was insidious in onset with no exaggerating or relieving factors and was non-radiating in nature. The patient also complained of non-ulcer dyspepsia, vomiting and weight loss for last one month. The family history and past medical or surgical history was non-contributory. On inspection, the abdomen appeared distended with no visible mass or pulsations. On palpation, there was palpable mass in epigastric area, extending into left hypochondrium, it was pulsatile and was able to lift the palpating hand with each aortic pulsation. There was no local rise in temperature but it was slightly ender in the right. It measured6 cm × 4 cm and moved with respiration. It was cystic in consistency with a smooth surface and was non-reducible. On percussion, a dull note was elicited over the mass and there was no evidence of shifting dullness. On auscultation, normal bowel sounds were heard in all quadrants of the abdomen.The ultrasonogram showed a large cystic lesion in left lobe which was suggestive of hydatid cyst. The contrast enhanced computed tomography scan was done which confirmed the findings of ultrasonogram abdomen. Patient was treated with albendazole therapy for two weeks by some private practitioner but in view of left lobe involvement with more than 5 cm size and non-responsive to albendazole therapy, patient was referred for surgical consultation and was lost to follow-up. Conclusion:Hydatid cyst is no uncommon disease but atypical location like in left lobe with size more than 5 cm with pulsatile nature warrants timely surgical intervention, so as to prevent rupture and its complications like peritonitis, cholangitis, sepsis and muti organ failure.