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Peritoneal hydatidosis can be primary or more frequently secondary to hydatid cysts in the liver or rarely in the spleen. Primary peritoneal hydatidosis is rare. The mechanism of peritoneal infestation in such cases is not clear. Dissemination via lymphatics or systemic circulation has been implicated as a possible route. Secondary peritoneal hydatidosis almost always arises from hepatic hydatid disease, and is related to seeding from spontaneous rupture of hepatic cyst into the peritoneum or spillage of cyst fluid during surgery. In both instances, depending on the patients immune response, this sudden release of hydatid antigens into the peritoneal cavity can result in anaphlaxis. If this does not occur, and viable organisms are present, then multiple cysts can develop. Case courtesy of Dr Frank Gaillard, Radiopaedia.org. From the case Peritoneal hydatidosis