 Good morning, myself, Dr. Pankaj Mahapandya, junior resident in Government Medical College, Kota. Putting my paper topic is diagnostic approach in bony hydratum cysts. After that, bone involvement of hydrated cyst is very rare, many species of hydrated disease. That is mistaken for sacroiliitis and provisional, severe, asculting, lower back pain. We are reporting a case of bony hydratum cysts with disseminated hydrocosy in 42 year old male patient that involve left pelvic bone, left sacroiliac joint and left femoral head and neck including muscles, the lung and the peritoneum, which are diagnosed by ultrasonography, CT scan and MRI. Learning objective to diagnose bony hydratum cysts and its type to differentiate them on imaging from their close differential diagnosis including aneurysmobonsis, giant cell tumor and fibrous dyslesia. A report of 42 year old male patient present to orthopedic department will complain of low back pain radiated towards the left thigh and led with no changes in pain when resting for 4 months. He had no medical resturant and was not taking any medications. We put the orthopedic advice of plan X-ray of pelvis and the patient was taken to the radiology department for X-ray. His complete blood count, seroactive levels, sediment, ESF and urea create an LNM, amino transverse and expected amino transverse level was normal with a limit. The radiological investigations, X-ray pelvis, grand radiogram, plan radiogram image number one show, multiple expansion lytic lesion with thinning of cortex are seen in left sacral area, SI joint left iliac bone and left HGM, left supine and inferior pubic ramy and left femur involving the head and neck of the femur. After abnormal X-ray finding, systemic serial radiological evolution of lesion by ultrason, NCCT, MRI and contrast MRI was done. On the ultrason B-mode USG, image number 2A and 2B is logitodial ultrason image of pelvis shows well-defined double-world cystic lesion with internal septation seen in pelvic cavity and intranospinal pain, plan of the left thigh and image number 2B. Then non-contrast NCCT of abdomen and pelvis, image number 3A, B, C and D shows multiple lytic lesion in left sacral area, left iliac bone, left HGM, left supine and inferior pubic ramy and left femur involving the left side neck of femur with multiple cystic lesion with internal septation seen in pelvic cavity and intranospinal pain. Then another image of NCCT abdomen and pelvis, image number 3E, F, G, H show multiple cystic lesion with internal septation seen in pelvic cavity, panzirectal lesion along left iliac vessels and left intranosal plan of left thigh and gluteal lesion with cystic lesion in left sacrum, left pelvic bone and left side head and neck of femur. Then another NCCT image of abdomen and pelvis, the image number 3E, I show large cystic lesion with internal septation in right lovelove of the lung. Image number 3J shows large cystic lesion with internal septation and few areas of calcification seen in left thigh muscles. The image number 3I shows lung hydrated cyst and the image number 3J shows the hydrated cyst in intranosal plan. Then radiological evaluation, MRI of abdomen and pelvis, image number 4A and 4B shows T2 weighted MRI image, shows multifocal introshift, T2 hyperintensistic lesion seen involving the left sacral area, left iliac bone, left HGM, left supine and fetal pubic ramy and left femur involving the left side neck of femur up to mid diaphysiological reason up to length of 12 centimeter. A pathological fracture of left sided neck of femur and multiple well defined T2 hyperintensistic lesion were noted in pelvic cavity and left thigh muscles. The image number 4C and 4D is the T2 ester. Images show multiple well defined T1 and multiple well defined T1 hyperintens and T2 hyperintensistic lesion were noted in the pelvic cavity, left sided pelvic muscles, gluteal muscles and left side imo in the region with large cyst measuring 50.81% of 12.81 mm in pelvic peri-visceral reason. The cystic lesion was seen at various stages of development with some of them having internal daughter cyst and few of them having a unilocular appearance of double membrane, both that indicated of high reticis cyst and its daughter hydrated cyst. The histopathological examinations, this image number 5A is a pathological examination level external, air cellular, dominated, cuticle of cyst 1 with multiple scoliosis. Image number 5B and 5C is an intraoperative image during the surgery shows a hydrated cyst and image number D is a postoperative. Images of pelvis and thigh hydrated cysts were accepted surgically. Discussion, the hydrated disease is a worldwide diagnosis caused by Echinococcus step 1. Infection with Echinococcus step 1, Echinococciosis has two forms, hydrated and unilocular cyst disease, caused by Echinococcus granulus and allular cyst disease caused by Echinococcus multilocular. Echinococcus granulus is the most common cause of hydrated disease in human. Human act as an intermediate host through the contact with the deputative host air through injection of contaminative fluid. Once the egg are in the intestinal tract, they hatch from Ocospil and then penetrate the common intracircidation. When they reach the host viscera, they insist on developing the mature global cyst. Sacroiliac involvement of hydrated disease is a rare manifestation of Echinococcus granulus. Echinococcus granulus tends to affect the liver in 50 to 70% of patients. They learn approximately 25% of patients and other organs including brain and heart less than 10% of patients. Incidents of bone Echinococcus is about 0.5 to 1% like sacroiliac joint. The patients are often asymptomatic and infection is usually detected incidentally with imaging studies performed for other reasons. Symptoms are usually related to mass effect caused by the enlarged cyst. The radiological finding of one hydrated cyst disease are not specific in the absence of visceral involvement and clinically acerological data is often impossible to make a correct diagnosis. Osteolytic areas of area varying size that may causes and they cause cortical thinning and destruction may be seen. The lack of osteoporosis and bone thinning in host bone and the presence of intralesinal calcification were found to be typical for hydrated bone disease and very useful for indifferential diagnosis. Other non-specific findings such as isinal areas of osteolysis with undefined margin between the undefined area of bone thinning and sclerosis and sometimes very austere reaction may be observed. Hydrated cyst may be visualized and evaluated with ultrafoam CT scan MRI because it is easy application and relatively low cost ultrafoam is most widely used modality. CT and MRI may be useful for case in which greater anatomical detail is required to establish the localization and number of cysts and the presence of ultracyst and presence of ultrasonic calcified cyst. USG ultralyzing on ultrafoam depending on biological activity of cyst ultrafoam appearance of hydrated disease can vary from rheocystic structure to calcified solid mass. Several calcification system are proposed based on ultrafoam appearance. In world in WHO classification system cystic echinocosyth type 1 CE1 refers to in the locale cyst type 2 CE2 is a multi-locale cyst type 1 CE and type 2 CE cysts are biologically active reasons. In type CE3rd cyst they may be free floating membrane within the cyst cavity that give rise to a water lily sign as solid component with ultracyst type CE3 cyst are considered transitional term of biological activity type CE4 and CE5 cysts are ecogenic and calcified structure that are often non-viable. On CT scan it may be useful in obese patient, patient with excess intestinal gas and those who have undergone previous abdominal surgery. On CT imaging cysts should be usually of water density, internal septa and wall calcification can be readily detected by the CT scan. CT is better than ultrafoam to detection of complications such as intravisory rupture, cyst infection. On CT scan around over 60 masses sharp and thin edges without contraff enhancement are typically one hydrated disease may also mimic excess air tumor on CT images. On MRI liver hydrated cyst may have T2 hypo intense ring that is thought to be prevent a collagen rich outer layer of cyst. Water cyst can be seen as a cystic structure attached to germinal layer that are hypo intense relative to intra cyst fluid on T1 weighted image and hyper intense on T2 weighted image. Differential diagnosis for hydrated cysts simple accepted cysts, aneurysmic bone cysts, giant cell tumor, hybrous dysregia, controsarcoma, lytic-excluerotic bone lesion, chronic osteomyelitis, neuro-cypermatosis, cyrocystic disease and tubular triglycosis. The complications of hydrated cysts are infection, delivery rupture, hand wage, mechanical damage to other tissue, allergic reaction, anaphytic shock, persistence of outer cyst, sudden intracystic decompression, leading or delivery cyst to life. Conclusion a kind of copiosis is a frequently misdiagnosed, they are missed in situation with uncommon localization when determined the cause of lower backache, back discomfort, it is important to consider hydrated cysts, especially when treating individual who have positive medical history resides in endemic reason. In this insistence on men with lower backache discomfort have cystic pelvic bone lesion, a femoral head, neck mass with fork tissue extension on CT and MRI scan since the patient reside in the patient for hydrated disease, widespread and there are concomitant lung and periodontal cysts, there should be suspicious that the illness has bone component which is verified histologically after surgically. These are my references topic. Thank you sir.