Textiloma or gossypiboma is a retained surgical swab in the body after an operation and is a complication that can remain undetected for many years and may represent a diagnostic dilemma depending on its location. It may be confused with several focal lesions and an accurate history taking, combined with clinical and instrumental data, is key to suspecting the diagnosis. We report a case of abdominal textiloma that was initially misdiagnosed as echinococcal cyst and discuss the differential diagnosis based on sonographic features and the WHO-IWGE classification. 1. Introduction The term textiloma or gossypiboma indicates a gauze pad that is left behind in a body cavity during a surgical operation. This type of complication is uncommon but may cause significant morbidity (close to 50%) and a high mortality rate (11–35%) [1–3]; furthermore, it may represent a diagnostic dilemma with important legal implications [3]. The incidence of textiloma is between 1 in 100 and 1 in 3000 for all surgical procedures [4–7] and 1 case in every 1000–1500 abdominal operations (most commonly complicated by its occurrence) per year [4, 6, 8]. The real incidence, however, may be higher because case numbers are calculated only based on malpractice claims and because of fear of legal repercussions [9]. Therapy consists of the removal of the textiloma on laparoscopy or laparotomy with treatment of complications. Only reoperation allows a definitive diagnosis [1, 10, 11]. We report a case of textiloma initially misdiagnosed as echinococcal cyst and discuss differential diagnosis based on sonographic features of the lesion. 2. Case Report A 55-year-old Italian woman was referred to our clinic for a suspected echinococcal cyst of the liver. She had type 2 diabetes mellitus, β thalassemia trait, dyslipidemia, and cervical arthrosis and had undergone cholecystectomy in 1973. In April 2006 an abdominal ultrasound performed at another hospital showed an enlarged liver with regular edges, steatosis, and a focal lesion 9.5 × 7.5？cm in diameter described as a cyst (suspected parasitic) partially solid within segments VI and VII. A hyperechoic area consistent with calcification was also found. The patient reported that she was aware of the cyst but could not provide any documentation. She was asymptomatic and stated that she had always refused to undergo further clinical investigations. The patient had three further hospitalizations in the same hospital for poorly controlled diabetes in October 2007, May 2009, and March 2010 during which repeated ultrasound scans showed no changes in the
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