Sonographic Classification of Caremani et al for Cystic Hydatid Disease

The sonographic appearance of abdominal Cystic Hydatid Disease can be classified using the criteria of Caremani et al from Arezzo, Italy.

Lesion Type	Class	Description
simple	Ia	simple cyst, echo-free without internal structures
	Ib	simple cyst, with fine and suspended echoes
multiple	IIa	multiple, continguous cysts, with or without thin echoes
	IIb	multiple cysts with septations, having a rosette, honeycomb or wheel-like pattern
wall detachment	IIIa	double-layer image
	IIIb	water lily pattern
mixed pattern	IV	mixed with fluid and solid/pseudosolid image; may have septations or heterogeneous pattern
heterogeneous	Va	ball of wool image, with an echogenic image intersected by anechoic canalized structures
	Vb	largely hypoechoic
hyperechoic	VIa	hyperechoic with snow-storm pattern; may have some internal calcification or focal wall calcification
	VIb	hyperechoic with inhomogeneous pattern; may have some internal calcification or focal wall calcification
calcified	VIIa	calcifications of wall
	VIIb	generalized calcification

Class	Correlation with Disease Status
Ia	typical of young cysts
Ib	echoes caused by hydatid sand
IIa	associated with exocystic proliferation
IIb	associated with endocystic proliferation
III	detachment of layers associated with early involution
IV	lesions may be either evolving or involuting
V	when a small amount of hydatid fluid remains, either as (a) collections in pseudocanals within the lesion or (b) between the sand and ruptured layers
VI	hydatid fluid disappears with further compression of hydatid sand and the ruptured germinal and laminated membranes
VII	involution of lesion with calcification

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