Masseter cysticercosis – a rare case diagnosed on ultrasound

Isolated Myocysticercosis of Pectoralis Major: A Rare Case

Isolated myocysticercosis is a neglected tropical disease and a rare diagnosis, with only a handful of cases being reported in the literature. It is highlighted that recently, it has not only been limited to endemic regions but also persists globally due to widespread migration from endemic regions. We present a case of isolated myocysticercosis of the right pectoralis major without neurological involvement in a non-pork-eater. High-resolution ultrasonography is an effective method of diagnosis. Anti-helmintic drugs are effective treatment options; if not responding, surgical excision is the management of choice. Ultrasound-guided excision is a better treatment modality to prevent complications.

Imaging findings of orofacial cysticercosis: report of 5 cases with review of literature

Cysticercosis, a fatal disease of parasitic aetiology seen in humans, is caused by ingestion of larvae of Taenia solium in form of raw or poorly cooked pork. Commonly seen in developing countries, it affects the brain, muscle, lungs, heart and liver and is rarely found in the maxillofacial region. Sometimes, the only evidence of cysticercosis could be the cystic swellings or nodules in the maxillofacial region. Such solitary clinical presentation can be diagnosed early with the aid of ultrasound (USG) and Magnetic resonance imaging (MRI). Here, we present 5 cases of intramuscular cysticercosis of Orofacial region which were initially diagnosed on ultrasonography and later confirmed by MRI and aspiration cytology. We have conducted a systematic review of PubMed Literature for Intramuscular cysticercosis of orofacial region and highlighted key imaging findings from 18 cases retrieved. Through this case series, we highlight the USG and MRI imaging features of intramuscular cysticercosis which are characteristic and diagnostic of the condition.

Skeletal Muscle Cysticercosis of the Calf: A Rare Case

Cysticercosis in humans is caused by larval cysts of the tapeworm Taenia solium. Any tissue in the human body can become infected by these larval cysts, but the central nervous system, skeletal muscles, subcutaneous tissues, and eyes are the most frequently affected. Muscle cysts are uncommon and typically do not present with any symptoms. In this study, we present a rare case of skeletal cysticercosis as a calf swelling and its management.

Review of cysticercosis of maxillofacial region and report of two cases

Cysticercosis is a parasitic infection caused by the larval stage of Taenia solium, which very rarely manifests in the maxillofacial region. It usually presents as a painless swelling. The most common site for maxillofacial cysticercosis are the tongue and lips. When humans accidently ingest the eggs of Taenia solium, they become the intermediate host, a role which is typically played by pig. This paper describes two cases of cysticercosis cellulosae, presenting as non-tender swelling of left buccal mucosa and left temporalis region respectively. Case reports available on PubMed were searched and a review was performed. Excision of cystic lesion was the treatment modality in majority of published reports. It is emphasised that cysticercosis should be considered in differential diagnosis of solitary painless swellings of oral and maxillofacial region, especially in patients from an endemic region.

PAIR as A Treatment Option for Isolated Intramuscular Cysticercosis: A Case Report

Cysticercosis is a parasitic disease caused by Taenia solium. Central nervous system is the most common site of infestation. Other organs infested are subcutaneous tissue, eye, muscle, liver, and lung. Cysticercosis in muscle can occur in three forms: myalgic type, mass-like pseudotumor, and rarely pseudohypertrophic type. Solitary cysticercosis of muscle without involvement of the central nervous system is rare. In this case report, percutaneous-aspiration-injection-reaspiration (PAIR) has been used as a treatment option for isolated intramuscular cysticercosis of the anterior abdominal wall. Interventional radiological management along with medical management was done to observe complete resolution of the cyst.

Role of Point-of-Care Ultrasound in Diagnosing Cysticercosis

Soft-tissue swelling is common in clinical practice and few common causes are lipoma, sebaceous cyst, abscess, etc. Though rare, myocutaneous cysticercosis can also be a differential. Point-of-care ultrasound (POCUS) can help diagnose myocutaneous cysticercosis, which can predict neurocysticercosis among patients presenting with headaches and seizures. Myocutaneous cysticercosis is often seen as a cystic lesion with eccentric hyperechoic foci (scolex) in ultrasound. Here, we describe a case of multiple swellings in the neck and forearm associated with headache, which turned out to be myocutaneous cysticercosis and neurocysticercosis, diagnosed with the help of ultrasound.

Solitary cysticercosis of the sternocleidomastoid muscle

Cysticercosis is a tropical infection caused by the larval form of Taenia solium and is usually known to affect the central nervous system. We report a young man who presented with a swelling in the neck and was treated with surgical excision and antihelminthics.

An atypical case of cutaneous cysticercosis in buccal mucosa

Cysticercosis is a recognized fatal disease to the humans. Taenia solium, a larval stage of pork tapeworm that causes cysticercosis which is an important cause of morbidity in the world. This case report shows the clinical presentations of an atypical case of cutaneous cysticercosis on the right buccal mucosa and its management. It presents the importance of thorough knowledge, proper investigation, symptomatic management with improved treatment regimens and important role of minimally invasive surgery. Its outcome and the treatment options mainly depend on the number, location, size and stage of parasites, as well as on the immune response of the host.

Lingual Cysticercosis: A Case Series with Review of Literature

Cysticercosis is a condition in which humans are infected by the larval form of Pork Tapeworm Taenia solium. Isolated lingual cysticercosis is a rare entity due to the high muscular activity and metabolic rate of tongue which prevents the development of larva. We present a series of three patients with isolated lingual cysticercosis. One patient was treated by medical management while the other two were treated with surgical excision followed by medical therapy. All patients are asymptomatic after repeated follow ups.

Presentation of cysticercosis of the lateral pterygoid muscle as temporomandibular disorder: A diagnostic and therapeutic challenge

Orofacial pain can often be the chief complaint of many systemic disorders. Cysticercosis involving the lateral pterygoids may cause limitation of mouth opening and may mimic clinical symptoms of a temporomandibular disorder. A 37-year-old female presented with 1-month-old complaint of limited mandibular range of motion. She reported a similar episode a year earlier and was diagnosed with a temporomandibular joint disorder by her primary dentist. Comprehensive intra- and extra-oral examinations were performed, which revealed a limitation of mouth opening accompanied by mild limitation of contralateral excursion. A magnetic resonance imaging revealed a ring-enhancing lesion within the left pterygoid muscle suggestive of cysticercosis. The patient was referred to her primary care physician for further treatment and given physical therapy (stretching exercises) to improve mouth opening. One week later, she developed lesions in the arm and trunk. Further ultrasound imaging of the abdomen and the forearms confirmed the diagnosis of cysticercosis. She was treated with albendazole, physiotherapy, joint stabilization appliance, and had eventual complete recovery. This case emphasizes the importance of diagnosis of a systemic condition that may have serious implications, if untreated, and the importance of a comprehensive evaluation, workup, and multidisciplinary management.

An epidemiological survey of the magnitude and local perceptions of porcine cysticercosis by two methods in Nyaruguru district, Rwanda

This study investigated the magnitude of porcine cysticercosis (PC), its risk factors, economic effects and the perceptions of 80 pig farmers from Nyabimata (n = 38) and Muganza (n = 42) and 20 registered butchers in the Nyaruguru district of Rwanda. January to December 2013 slaughter records from Kamirabagenzi market were also analysed for PC diagnoses based on the tongue test and meat inspection. During this period, the responding farmers' records showed a tongue test-based PC magnitude (3.9%, n = 984) which was lower than the collective tongue test-based PC magnitude of 9.2% (n = 1720) at Kamirabagenzi (p < .05). The overall magnitude of PC based on routine meat inspection diagnosis at Kamirabagenzi was 4%. The overall magnitude of PC for respondents using Free-range production systems (7.9%) was significantly greater than for those in Semi-intensive (2.1%) and Intensive production systems (1.5%) (p < .05). Though most farmers (90%) knew that PC is zoonotic, only 22.5% of the farmers opted for treatment of PC-infected pigs and 52.5% were willing to seek veterinary inspection while the rest (25%) opted to circumvent veterinary inspection (P > .05). Most butchers (70%) indicated they would circumvent veterinary inspection and continue to slaughter PC-positive animals whilst the rest (30%) indicated they would resell PC positive animals to defray costs (P < .05). The low sensitivity and specificity of methods used for PC detection in the study, implies that this may just be the tip of an iceberg and the actual magnitude is most likely to be much higher. In conclusion, PC is endemic in the Nyaruguru district of Rwanda with a high proportion of positive animals. The condition has public health implications and is worsening the economic plight of the impoverished Nyaruguru community.

Oral Cysticercosis: A Case Series and Review of Literature

The cysticercus is the larval form of the pork tapeworm. Oral cavity involvement of cysticercosis is rare but frequently reported from developing countries. This report presents 3 cases of oral cysticercosis involving the tongue and buccal mucosa in isolation. All 3 patients were treated with surgical excision and had an uneventful postoperative course. A brief review of the PubMed English-language literature search is presented. Oral cavity involvement with cysticercosis presents a diagnostic dilemma. Management is primarily surgical and carries an excellent prognosis.

Solitary myocysticercosis of masseter muscle: A rare presentation

Cysticercosis in human is caused by larva of cyclophyllid cestode named Taenia solium. Worm infestation is quite common in developing countries due to poor sanitation, habit of open defection. This condition primarily involves central nervous system. We present a rare case of myocysticercosis involving the masseter muscle.

A Classic Case of Subcutaneous Cysticercosis: A Rare Case with Sonological Findings and Review of Literature

Background

Cysticercosis is a parasitic infection caused by the larval stages of the pork tapeworm, Taenia solium. The subcutaneous form of the disease is a relatively rare clinical entity. Despite its rarity, it is imperative for a radiologist to be aware of this subcutaneous form of the disease and its various radiological patterns while evaluating any subcutaneous swelling. In this paper, we aimed to describe a typical case of ‘subcutaneous cysticercosis involving the left anterior chest wall’ with high resolution ultrasound findings. We also discussed the role of other imaging modalities in a case of subcutaneous cysticercosis. To the best of our knowledge, our case is only the second documented case report of sonological evaluation of subcutaneous cysticercosis involving the left anterior chest wall and the first case with high resolution ultrasound images of the lesion.

Case Report

An 11-year-old male presented with a painless, subcutaneous swelling over the left anterior chest wall for the last 2 months. High resolution ultrasound showed a well-defined, thin-walled, cystic lesion with an eccentric, echogenic focus in the subcutaneous plane. On change of the posture of the patient, this focus showed mobility. The hypoechoic area surrounding this cyst showed significant exudative fluid collection with diffuse, floating echoes and thin, incomplete internal septations. The adjacent soft tissues were thickened and irregular, suggestive of edema. This was followed by an excision biopsy. Histopathological examination revealed cysticercus cellulose parasite with an extensive mixed inflammatory cell infiltrate in the surrounding tissue. The patient was also administered oral antihelminthic therapy. Repeat ultrasound examination at the end of this management regimen showed complete healing with no e/o any remnant or recurrent cystic lesion, abscess or edema in the subcutaneous plane.

Conclusions

Subcutaneous cysticercosis is a relatively rare form of cysticercosis but should always be born in mind during the evaluation of subcutaneous swellings. High resolution ultrasound is a valuable, safe, nonionizing, cost-effective, widely-available, and easily-reproducible imaging tool for diagnosis of subcutaneous cysticercosis. There is a wide spectrum of ultrasound patterns of subcutaneous cysticercosis. In classic cases with a cyst containing a scolex within and with a surrounding abscess, high resolution ultrasound should always be the primary mode of diagnosis, thus avoiding unnecessary fine needle aspiration cytologies.

Orofacial cysticercosis: Report of a rare case with review of literature

Cysticercosis is common in developing countries in which the combination of rural society, crowding, and poor sanitation facilities allows greater contact between humans and pigs and thus more opportunities for fecal contamination of food and water occurs. They are rarely located in oral and perioral tissues, particularly in the muscles of mastication, muscle of the facial expression, suprahyoid muscles, and postcervical musculature and also as in the tongue, buccal mucosa, and lip. Cysticercosis is a potentially fatal parasitic disease that rarely found in the maxillofacial region in humans. This paper reports the case of a young female patient presented with isolated lesion of cysticercosis involving buccinator muscle. In conclusion, we suggest that cysticercosis should be considered in the differential diagnosis of intraoral solitary nodules within the oral and maxillofacial region, especially in endemic areas. High-resolution ultrasonography is an excellent noninvasive and cost-effective modality for the diagnosis and also suggests that localized parasitic infections such as Cysticercus cellulosae can be successfully treated with conservative management using oral antiparasitic (antihelminthic) medication.

Isolated intramuscular cysticercosis: Clinicopathological features, diagnosis and management - A review

Cysticercosis is an emerging parasitic disease affecting worldwide population. There is large volume of data present in the literature for neurocysticercosis. The isolated intramuscular involvement of cysticercosis is uncommon and there are only sporadic case reports available. There is no review available in the literature which gives in detail clinicoradiological features and management of isolated intramuscular cysticercosis. Knowledge about such a presentation is important especially in developing countries and to differentiate the condition from a variety of other similar conditions.

Isolated pancreatic cysticercal cyst presenting as a diagnostic challenge: diagnosis and treatment review

Human cysticercosis most commonly affects the subcutaneous tissues, skeletal muscles, lungs, brain, eyes, liver and, rarely, the heart, thyroid and pancreas. Owing to vague clinical presentation and unfamiliarity of clinicians with this entity, it is difficult to diagnosis when seen as an isolated cyst. We present a case of a 16-year-old boy who presented with an upper abdominal lump and jaundice. Ultrasonography (USG) and MRI of the abdomen were carried out, which revealed a cystic mass (8.5 × 7 × 7 cm) in the pancreas. No evidence of solid component or papillary projections was noted within the lesion. Tumour markers carcinoembryonic antigen (CEA) and cancer antigen (CA 19-9) were normal. Fine needle aspiration cytology was performed, which revealed the presence of cysticercus larvae, along with a foreign body giant cell reaction. The patient was treated with therapeutic aspiration and antihelminthic therapy. Since then, he has been symptom free and under regular follow-up for the last 1 year. A diagnosis of cysticercal cyst at atypical sites is very rare and depends mainly on histopathological examination, which, along with USG and MRI, can give an accurate analysis. These cysts can be very well treated non-surgically with antihelminthics and aspiration.

Cysticercosis of the masseter: MRI and sonographic correlation

Cysticercal involvement of the masseter is an uncommon manifestation of a relatively common parasitic infestation. Sonographic evaluation of many isolated cases of cysticercosis has been extensively described. However, there are scanty reports on MRI appearance of cysticercal involvement of the masseter. This report presents classical imaging appearance of cysticercal involvement of the masseter on sonography and MRI. The pattern of the disease and MRI appearance of lesions in the masseter, highlighting the role of diffusion-weighted images, are described.

Cysticercosis of Soleus muscle presenting as isolated calf pain

CNS is the most common site of involvement by cysticercosis. Symptomatic involvement of isolated skeletal muscle by solitary cysticercosis cyst is extremely rare. We report a rare and unusual case of cysticercosis presenting as acute calf pain, which is a diagnostic challenge. But the diagnosis was reached by sero-radiological examination and patient was managed conservatively by medical means.

Solitary Cysticercosis of the Temporalis Muscle: Report of a Rare Case

Patient presented with swelling over right temporal region causing the dilemma over diagnosis. Sonography and CT scan confirmed the presence of cysticercus in right temporal region. Pharmacological management was instituted and the cyst resolved eventually. Ultrasonography and CT imaging play an important role in establishing the diagnosis of rare case of cysticercosis of temporalis muscle and can be treated successfully by pharmacological modality.

Importance of ultrasonography and magnetic resonance imaging in diagnosis of cysticercosis of temporalis muscle mimicking temporal space infection

Cysticercosis cellulosae, caused by the larval stage of Taenia solium is a common parasitic infection in Indian subcontinent. Although cysticercosis is common in other parts of the human body, its involvement with temporalis muscle is an extremely rare entity and demands documentation. This paper reports a case of cysticercosis cellulosae in a 35-year-old male patient within the temporalis muscle mimicking temporal space infection; due to the presence of concomitant dental infection, which was diagnosed with the help of high resolution ultrasonography and magnetic resonance imaging and managed conservatively using oral antiparasitic medication. Here, in this case report, we are emphasizing the importance of imaging modalities in diagnosing space infection and cysticercosis.

Cysticercosis involving muscle of mastication: a review and report of two cases

Cysticercosis is a parasitic infection caused by the larval stages of the parasitic cestode, Taenia solium. It is a common disease in developing countries where it is also endemic. The central nervous system (CNS) is the most important primary site of infection and the disease can present with solitary or multiple space occupying lesions. Cases of cysticercosis presenting as isolated muscle mass (pseudotumours) without involvement of the CNS have also been recently described in the literature. We present two cases who presented to us with pain, swelling, and tenderness involving the temporalis muscle along with trismus. Ultrasonography and MRI findings were suggestive of cysticercosis involving the temporalis muscle which resolved after the albendazole therapy.

Encysted Tenia solium larva of oral cavity: Case report with review of literature

Cysticercosis is caused by the larvae of the pig tapeworm, Tenia solium. Oral cysticercosis is a rare event and is often a diagnostic challenge to the clinician. We report a 12-year-old girl who presented with a single, painless, nodule on the lower lip that was diagnosed as cysticercosis. Current literature on the clinical presentations, investigations, and treatment of the condition has been reviewed in this article. We have also proposed a set of criteria for the diagnosis of oral cysticercosis.

Isolated Muscular Cysticercosis: A Rare Pseudotumor and Diagnostic Challenge, can It be treated Nonoperatively? A Report of Two Cases and Review of Literature

Cysticercosis, an infection with the larval form of pork tape worm, Taenia solium, commonly presents with multiple muscular cysts or CNS involvement. Due to vague clinical presentation and unfamiliarity of clinicians with this entity, it is difficult to diagnosis when seen as an isolated cyst. Traditional treatment is surgical excision and a course of deworming agents. We present two cases of isolated muscular cysticercosis diagnosed by USG, MRI and blood tests, who responded successfully to oral medication without need of operative intervention.

Case reports

A 45-year-old male patient had a tender 2 week swelling of 4 × 5 cm on medial right proximal calf. A 26-year male presented with discomfort and diffuse 6 cm swelling at inner left forearm. In both ultrasound showed characteristic hypoechoic cyst with hyperechoic scolex, and MRI revealed isolated cyst surrounded by inflamed muscles. FNAC confirmed cysticercosis, and the patient responded to oral albendazole (3 weeks) with oral steroids (2 weeks).

Conclusion

Although rare, possibility of isolated muscular cysticercosis should always be considered in any small musculoskeletal soft tissue swelling presenting with nonspecific clinical findings. Both our patients responded to medical therapy and were disease free, as confirmed at 3 months by follow-up MRI. These cysts can be confidently diagnosed on the basis of ultrasound and MRI, and can be very well-treated nonsurgically with an oral drug regimen consisting of albendazole and steroid.

How to cite this article

Rangdal SS, Prabhakar S, Dhatt S S, Prakash M, Dhillon MS. Isolated Muscular Cysticercosis: A Rare Pseudotumor and Diagnostic Challenge, can It be treated Nonoperatively? A Report of Two Cases and Review of Literature. J Postgrad Med Edu Res 2012;46(1):43-48.

Soft tissue cysticercosis - Ultrasonographic spectrum of the disease

This case series emphasizes the role of USG in the diagnosis of isolated soft tissue cysticercosis. We assessed its value for identifying features such as the location of the cyst, the presence or absence of abscess, and the presence or absence of a scolex within the cyst. Three USG patterns were seen and are described.

Cysticercosis of the Breast

Cysticercosis, although common in developing nations, is an uncommon cause of a breast lump. This article reports a case from India, where a young woman presented with a firm, nontender breast lump. Breast sonography imaging with a high-frequency transducer revealed a well-defined cystic lesion with an internal echogenic nodule and surrounding hypoechoic area. Subsequently, fine-needle aspiration cytology was performed, which confirmed the diagnosis of cysticercosis.