Liver: hydatid cyst imaging: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Liver: hydatid cyst imaging

Sample item

A 35-year-old farmer from a sheep-rearing region has vague right upper quadrant discomfort. Ultrasound shows a 9 cm cystic lesion in the right lobe with a floating, wavy, detached membrane inside the fluid. Which sign does this describe, and what does it indicate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Water lily sign, a detached endocyst membrane in a hydatid cyst

In Echinococcus granulosus infection the cyst has an outer pericyst, a laminated membrane and an inner germinal layer. When the endocyst membrane detaches and floats on the cyst fluid it produces the water lily sign, which is a specific feature of a hydatid cyst. Treatment is albendazole with PAIR or surgical removal, taking great care to avoid spillage of cyst contents.

Option by option

  • A. Rigler sign, gas in the biliary tree

    Rigler sign is gas in the bowel wall on both sides, seen in pneumoperitoneum, and is not a sign inside a liver cyst.

  • B. Target sign, concentric bowel wall thickening

    Target sign is concentric bowel wall layering in intussusception or inflammatory bowel disease, not a feature of liver cysts.

  • C. Whirlpool sign, mesenteric twisting

    Whirlpool sign is the twisted mesentery of midgut volvulus and is unrelated to a liver cyst.

  • D. Water lily sign, a detached endocyst membrane in a hydatid cyst (correct)

    Correct. A floating membrane within the cyst fluid is the water lily sign of a hydatid cyst.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is D, Water lily sign, a detached endocyst membrane in a hydatid cyst. In Echinococcus granulosus infection the cyst has an outer pericyst, a laminated membrane and an inner germinal layer.

Why is "Rigler sign, gas in the biliary tree" not the answer?

Rigler sign is gas in the bowel wall on both sides, seen in pneumoperitoneum, and is not a sign inside a liver cyst.

Why is "Target sign, concentric bowel wall thickening" not the answer?

Target sign is concentric bowel wall layering in intussusception or inflammatory bowel disease, not a feature of liver cysts.

Why is "Whirlpool sign, mesenteric twisting" not the answer?

Whirlpool sign is the twisted mesentery of midgut volvulus and is unrelated to a liver cyst.

What concept does this question test?

It tests Liver: hydatid cyst imaging in General Surgery. When the endocyst membrane detaches and floats on the cyst fluid it produces the water lily sign, which is a specific feature of a hydatid cyst. Treatment is albendazole with PAIR or surgical removal, taking great care to avoid spillage of cyst contents.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Liver: hydatid cyst imaging?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.