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The sonographic appearance of echinococcal lesions of the liver was studied in 59 patients. We have proposed a classification of these lesions that reflects the pathology and natural history of the disease: type I, simple fluid-filled cysts; type IR, lesions containing undulated membranes that represent detached endocyst secondary to rupture; type II, lesions that contain daughter cysts and/or a formed echogenic material we call matrix; and type III, dead, densely calcified lesions. The natural progression of hepatic echinococcal cysts is from type I to type III. Daughter cyst formation is part of the natural aging process. When hydatid cysts are infected, they lose their characteristic sonographic appearance and become diffusely hyperechoic.

A retrospective analysis was made of the radiologic features of 30 cases of mycetoma. Conventional radiographs, computerized tomography (CT), and isotope bone scans were assessed. Soft-tissue swelling was the only abnormality in 27%. Periosteal reaction was present in 67%, sclerosis in 53%, endosteal reaction in 50%, and cortical erosions in 43%. Cavities which were found in 33% are important as predictors of the causative micro-organism. Conventional radiographs are essential to the management of mycetoma as bone involvement makes non-surgical cure unlikely. The role of CT in diagnosis and management appears to be minor, except when the thigh is involved. Isotope bone scanning appears to have no value in either diagnosis or management.

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