Water lily or Camelotte sign in pulmonary hydatid cyst − an orphan disease

Sudheer Tale, Soibam Pahel Meitei, Mrudula Kolli
Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Web Publication

20-Jun-2019

Correspondence Address:
Dr. Sudheer Tale
Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, Rishikesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jacp.jacp_23_18

Case

A 20-year-old male without any previous comorbidities presented to the pulmonary medicine outpatient department with complaints of dull aching chest pain on right side, dry cough, and shortness of breath for the past 1 year. He was nonvegetarian and had no addictions. On general physical examination, his vitals were stable and respiratory system examination revealed decreased breath sounds in the right hemithorax. All his routine blood investigations were normal. Chest radiograph revealed homogenous opacity in the right middle and lower zones. Contrast-enhanced computed tomography of thorax and abdomen showed a well-defined encapsulated cystic lesion of size 12 × 10 × 14 cm with internal floating membranes (water lily sign or Camelotte sign) with mass effect on adjacent lung parenchyma causing atelectasis and compression of adjacent vessels [Figure 1]. Hydatid serology [Immunoglobulin G (IgG)] was positive. The patient was treated symptomatically and referred for surgical intervention.

Figure 1 Contrast-enhanced computed tomography image of chest showing water lily sign. Click here to view

Discussion

Cystic echinococcosis is a zoonotic disease caused by ingestion of food contaminated with eggs of Echinococcus species. Humans are accidental hosts. Liver is the most common site of involvement followed by lungs. Due to compressible nature of lungs, the cysts tend to grow faster in size and rarely calcify.^[1] Hydatid cyst consist of three layers: the outermost layer is pericyst formed by host tissue, middle layer is ectocyst, and innermost is endocyst. Rupture of hydatid cyst occur in 49% of cases.^[2] Rupture of endocyst results in floating membranes within the pericyst mimicking the appearance of water lily hence known as “water lily or Camelotte sign.”^[3] Definitive treatment for pulmonary hydatidosis is surgery.^[4]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

References

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3.	Von Sinner WN. New diagnostic signs in hydatid disease; radiography, ultrasound, CT and MRI correlated to pathology. Eur J Radiol 1991;12:150-9.
4.	Sarkar M, Pathania R, Jhobta A, Thakur BR, Chopra R. Cystic pulmonary hydatidosis. Lung India 2016;33:179-91.   [PUBMED]  [Full text]