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204 ineligible for surgical intervention and potential liver transplantation. In 2011, AE was diagnosed on the basis of epidemiological data (red foxes observed in household), diagnostic imaging, and a sequen‐ tial enzyme ‐linked immunosorbent assay using Em2 antigen and Western blotting, which con‐ firmed Echinococcus multilocularis infection.2 Al‐ anine and aspartate transferase levels, bilirubin levels, and activated partial thromboplastin time were normal on admission. Abdominal ultraso‐ nography revealed a single gallstone (4 mm in size) and a 92‐mm lesion with calcifications in the liver segment. There was no nodular remod‐ eling of the liver, and hepatitis B and C virus in‐ fections were excluded. In 2016, computed to‐ mography angiography revealed collateral circu‐ lation (lumbar and paraspinal veins to the azygos vein and hemiazygos vein) and inferior vena cava (IVC) subphrenic constriction. The IVC throm‐ bosis may have formed as a result of the parasit‐ ic masses infiltrating the main venous trunks. This condition is rarely described in the course of AE. The patient was treated with albendazole A 34 ‐year ‐old man was hospitalized in the De‐ partment of Tropical and Parasitic Diseases, Poznan University of Medical Sciences, Poland, due to compensated liver cirrhosis (FIGURE 1A) in the course of inoperable alveolar echinococcosis (AE). On admission in September 2018, we found an enlarged liver, palm ‐tree sign on the skin of the abdominal cavity, and a single spider angio‐ ma on the back. Laboratory tests revealed elevat‐ ed levels of γ ‐glutamyltransferase, alkaline phos‐ phatase, and unconjugated bilirubin. Addition‐ ally, we found microcytic anemia, iron deficien‐ cy, low ferritin levels, a prolonged prothrombin time, and increased D ‐dimer levels. On imaging, a large focal lesion (78 × 59 mm) was demonstrat‐ ed, originally occupying liver segments IV and VIII (FIGURE 1B), with invasion of the diaphragm and right lung segments VII and VIII. The patient was classified as the P4N1M1 group1 according to the PNM (P = parasitic mass, N = involvement of neighboring organs, M = metastasis) classifi‐ cation and class A according to the Child–Pugh score, and he obtained 9 points in the Model for End ‐Stage Liver Disease score. He was considered CLINICAL IMAGE

Vena cava inferior thrombosis in the course of advanced alveolar echinococcosis