Khandwala K, Sajjad M, Hussain Z, Zeeshan M, Hilal K. Hepatic hydatid cyst disease in low- and middle-income countries: Spectrum of imaging findings and complications. World J Hepatol 2026; 18(8): 123946 [DOI: 10.4254/wjh.123946]
Corresponding Author of This Article
Kiran Hilal, Associate Professor, Department of Radiology, Aga Khan University, National Stadium Road, Karachi 74500, Pakistan. kiran.hilal@aku.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
review-article
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Khandwala K, Sajjad M, Hussain Z, Zeeshan M, Hilal K. Hepatic hydatid cyst disease in low- and middle-income countries: Spectrum of imaging findings and complications. World J Hepatol 2026; 18(8): 123946 [DOI: 10.4254/wjh.123946]
World J Hepatol. Aug 27, 2026; 18(8): 123946 Published online Aug 27, 2026. doi: 10.4254/wjh.123946
Hepatic hydatid cyst disease in low- and middle-income countries: Spectrum of imaging findings and complications
Kumail Khandwala, Mariam Sajjad, Zainab Hussain, Mohammad Zeeshan, Kiran Hilal
Kumail Khandwala, Mariam Sajjad, Zainab Hussain, Kiran Hilal, Department of Radiology, Aga Khan University, Karachi 74500, Pakistan
Mohammad Zeeshan, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi 74500, Pakistan
Author contributions: Khandwala K and Sajjad M conducted the literature review, did the analysis and drafted the original manuscript; Hussain Z and Zeeshan M provided data interpretation, and performed critical review; Khandwala K and Hilal K conceptualized and designed the study, created the images, supervised, and made critical revisions; and all authors prepared the draft and approved the submitted version.
AI contribution statement: The authors take full responsibility for the content of this manuscript. ChatGPT (OpenAI) was used for limited language refinement and drafting support for selected sections, including the abstract and core tip, under full author supervision. All AI-assisted outputs were carefully reviewed, edited, and approved by the authors. AI tools were not used to generate original scientific data, perform scientific analyses, or draw scientific conclusions. All figures are original patient imaging data and were not AI-generated.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Kiran Hilal, Associate Professor, Department of Radiology, Aga Khan University, National Stadium Road, Karachi 74500, Pakistan. kiran.hilal@aku.edu
Received: June 3, 2026 Revised: July 15, 2026 Accepted: July 27, 2026 Published online: August 27, 2026 Processing time: 77 Days and 16 Hours
Abstract
Hepatic hydatid cyst disease is a significant public health issue in endemic low- and middle-income countries, and imaging plays a pivotal role in diagnosis, classification, management, and follow-up. In resource-limited settings, ultrasound (US) is often the imaging modality of choice, with computed tomography (CT) and magnetic resonance imaging (MRI) usually reserved for complex or atypical cases. This pictorial review illustrates the characteristic and atypical imaging features of hepatic hydatid cysts across US, CT, and MRI, emphasizing practical imaging approaches applicable in low- and middle-income countries. US features include daughter cysts, hydatid sand, and detached membranes, whereas CT provides a more detailed assessment of cyst morphology, calcifications, and complications. MRI offers superior soft-tissue contrast and improved evaluation of biliary involvement and complex disease. Important complications include exophytic growth, rupture, transdiaphragmatic thoracic involvement, perforation into hollow viscera, peritoneal seeding, biliary communication and abdominal wall invasion. The US based World Health Organization-Informal Working Group on Echinococcosis classification is also illustrated, highlighting its role in guiding treatment and follow-up. A structured, image-based approach using available modalities enables accurate diagnosis and effective management, whereas pictorial recognition of key imaging features facilitates early detection and improved outcomes in resource-limited settings.
Core Tip: Hepatic hydatid disease is highly prevalent in low- and middle-income countries, where imaging is central to diagnosis, staging, and management. This pictorial review demonstrates the spectrum of imaging findings across ultrasound, computed tomography, and magnetic resonance imaging, emphasizing practical, resource-adapted interpretation. Key typical and atypical features, complications, and characteristic radiologic signs are illustrated alongside the World Health Organization-Informal Working Group on Echinococcosis classification to reinforce standardized staging. By focusing on commonly available modalities and real-world diagnostic challenges, this review aims to improve recognition, guide treatment decisions, and enhance diagnostic accuracy, particularly in low- and middle-income countries.
