**2.2.1.4 Laboratory findings of CE**

Routine laboratory tests show non-specific results. Patients with rupture of a cyst into the biliary tree can show transient elevations of GGT or alkaline phosphatase concentrations, often associated with hyperamylasaemia and eosinophilia (>500/µl). When cyst is ruptured eosinophilia achieves higher concentrations.

**CE2:** Multivesicular, multiseptated cysts; cysts septations produce "wheel-like" structures, and presence of daughter cysts is indicated by "rosette-like" or "honeycomb-like"

**CE3:** Unilocular cyst which may contain daughter cysts. Anechoic content with detachment of laminated membrane from the cyst wall is visible as floating membrane or as "water-lily

Transitional stage. Cyst which may degenerate further or may give rise to daughter

**CE4:** Heterogenous hypoechoic or hyperechoic degenerative contents. No daughter cysts. May show a "ball of wool" sign which is indicative of degenerating membranes.

US features are not pathognomonic and further diagnostic tests are required to

**CE5:** Cysts characterized by thick calcified wall that is arch shaped, producing a cone

Diagnosis is uncertain. Features are not pathognomonic but highly suggestive for *E.* 

Routine laboratory tests show non-specific results. Patients with rupture of a cyst into the biliary tree can show transient elevations of GGT or alkaline phosphatase concentrations, often associated with hyperamylasaemia and eosinophilia (>500/µl). When cyst is ruptured

sign" which is indicative of wavy membranes floating on top of remaining cyst fluid. Cyst form may be less rounded because of decrease of intra-cystic fluid pressure.

structures. Daughter cysts may partly or completely fill the unilocular mother cyst.

Size variable: CE1s (< 5.0 cm), CE1m (5 – 10 cm), CE1l (> 10cm)

Pathognomonic signs include visible cyst wall and snow flake sign.

Size variable: CE2s (< 5.0 cm), CE2m (5 – 10 cm), CE2l (> 10cm).

Size variable: CE3s (< 5.0 cm), CE3m (5 – 10 cm), CE3l (> 10cm).

Size variable: CE4s (< 5.0 cm), CE4m (5 – 10 cm), CE4l (> 10cm).

Size variable: CE5s (< 5.0 cm), CE5m (5 – 10 cm), CE5l (> 10cm).

Degree of calcification varies from partial to complete.

 Cyst wall is visible. Normally round or oval.

 Cyst wall normally visible. Normally round or oval.

Ultrasound features are pathognomonic.

Ultrasound features are pathognomonic.

Most cysts of this type are not fertile.

ascertain a diagnosis.

Cyst not fertile in most cases.

**2.2.1.4 Laboratory findings of CE** 

eosinophilia achieves higher concentrations.

 Status: active. Usually fertile.

 Status: active. Usually fertile.

Status: transitional.

cysts.

Status: inactive.

shaped shadow.

Status: inactive.

*granulosus*.
