Musculoskeletal involvement in cystic echinococcosis: report of eight cases and review of the literature

Primary Hydatid Cysts in the Extremities: A Systematic Review of the Literature

Primary hydatid cysts (PHCs) in the extremities are uncommon, presenting in the majority of cases with atypical clinical features. Radical surgical excision remains the mainstay of treatment. The aim of our study was to accumulate the already published data on PHCs in the extremities in terms of demographic, diagnostic, and therapeutic aspects. Three electronic databases were meticulously searched for articles published until 2024. A total of 85 studies comprising 118 patients were finally included in our review. Sixteen patients (13.5%) were diagnosed with a hydatid cyst in their upper extremity, 94 (79.7%) with a PHC in the lower extremity, and eight (6.8%) with an echinococcal cyst in the axilla. Pain and swelling were the most frequent symptoms, whereas only two patients were completely asymptomatic. The mean lesion size was 11.6 ± 7.1 cm. Preoperative serology investigation was reported in 82 out of 118 (69.5%) patients; among them, 33 (44.6%) cases had a positive preoperative serology test. The vast majority of patients (96.6%) were treated with an interventional procedure either surgical or radiological, and only seven experienced postoperative complications. No anaphylactic reaction was described perioperatively. Although preoperative diagnosis of PHCs is challenging, they should be considered in the differential diagnosis of soft tissue lesions. Treatment strategies should be individualized on a patient basis, while radical surgical excision remains the gold standard treatment.

Imaging features of soft-tissue infections

Skin and soft tissues are among the most common sites of infections. Infections can involve the superficial epidermis to deep muscles and bones. Most infections spread through contiguous structures, although hematogenous spread can occur in the setting of an immunocompromised state and with atypical infections. While clinical diagnosis of infections is possible, it often lacks specificity, necessitating the use of imaging for confirmation. Cross-sectional imaging with US, CT, and MRI is frequently performed not just for diagnosis, but to delineate the extent of infection and to aid in management. Nonetheless, the imaging features have considerable overlap, and as such, it is essential to integrate imaging features with clinical features for managing soft tissue infections. Radiologists must be aware of the imaging features of different infections and their mimics, as well as the pros and cons of each imaging technique to properly use them for appropriate clinical situations. In this review, we summarize the most recent evidence-based features of key soft tissue infections.

Musculoskeletal involvement in neglected tropical diseases: a comprehensive review

Neglected tropical diseases (NTDs) encompass a group of diseases predominantly found in tropical regions, with origins dating back to their inclusion in the United Nations Millennium Development Goals in 2000. This initiative aimed to raise awareness and global funding to combat these diseases, which thrive in areas with limited sanitation, healthcare, and education. NTDs are caused by various pathogens such as bacteria, fungi, parasites, and viruses and affect over two billion individuals in resource-poor communities, leading to preventable deaths and devastating consequences. While the musculoskeletal system is only occasionally affected, the resulting chronic disabilities prevent individuals from working, posing a significant socioeconomic burden in this region of the world. Some NTDs exhibit distinct imaging features, and radiologists need to be aware of these characteristics to facilitate early treatment. In this review, we delve into musculoskeletal NTDs, focusing on clinical features and imaging findings, differential diagnosis, and clinical management.

A primary hydatid cyst in the mesorectum uncommon location - A rare case report

INTRODUCTION AND IMPORTANCE

The tapeworm Echinococcus granulosus sensu lato is the causative agent of cystic echinococcosis (CE), often known as hydatid disease. Over two-thirds of all occurrences of this zoonotic disease process in humans are caused by hepatic infection. Clinicians should have a low threshold to consider CE as a differential diagnosis in patients with positive serology and suggestive radiological findings, especially in endemic regions, because signs and symptoms are typically non-specific, especially in early disease.

CASE PRESENTATION

This is a case report of a 26-year-old male who presented with increasing lower abdominal discomfort, mild pain, sense of fullness in the lower abdomen, described as (I'm having a ball in my abdomen), with a history of early satiation and tenesmus, frequency of urine, and history of weight loss and general weakness of 10-months duration. The diagnosis of a hydatid cyst in the mesorectum was made. The cyst was completely excised via open surgery. No local recurrence has been detected up to the present time.

CLINICAL DISCUSSION

Given how uncommon a site like this is, this case report helps broaden the differential diagnosis of soft tissue masses in such settings, especially in endemic areas. It also describes in great detail how these locations are affected by the hydatid disease.

CONCLUSION

The mesorectal hydatid cyst was challenging to diagnose initially due to its infrequent incidence and uncommon location. In a few rare cases, the diagnosis of a hydatid cyst might be guided by the detection of the cyst membrane and daughter cysts in the germinal membrane.

The unsolved problem of musculoskeletal hydatid disease: two case reports

BACKGROUND

Hydatidosis is a parasitic infection caused by Echinococcus granulosus and humans are usually an accidental intermediate host. Involvement of the musculoskeletal system is reported to occur in 0.5% to 4% of the cases.

CASE PRESENTATION

We present our experience with two cases of musculoskeletal hydatidosis in black African patients that required orthopaedic surgical intervention. A 51-year-old black African female presented with right hip hydatid disease and a 37-year-old black African female presented with the disease affecting the left shoulder. Both patients presented with joint pain and reduced range of motion. The patient with involvement of the shoulder had a background history of human immunodeficiency virus, this was not present with the other patient. Diagnostic work-up confirmed peri-articular hydatid disease and both patients were surgically managed with arthroplasty. Post-operative complications encountered include hardware loosening from bone lysis and hardware failure.

DISCUSSION

The medical literature describes a limited number of cases of peri-articular musculoskeletal hydatid disease. Patients are often subjected to many investigations, prolonged treatment periods and multiple surgeries. Concurrent use of medical and surgical treatment is advocated however, the choice of surgery is individualised.

CONCLUSION

Hydatid disease must always feature in the differential diagnosis of multiple lytic bone lesions and radical surgical intervention may be required from the outset.

Primary muscular hydadit cyst: Case report

Primary hydatid disease of the skeletal muscle without systemic involvement is rare. Since the infection appears on clinical examination to be a soft-tissue tumor. It is important to have a preoperative radiological evaluation, particularly with magnetic resonance imaging (MRI) to avoid biopsy or improper cyst management during surgery. We present a unique case of a primary hydatid cyst manifesting as an expanding soft-tissue mass in a 31-year-old woman's left thigh with magnetic resonance imaging revealed a very suggestive aspect of hydatid cyst in the adductor muscles and shows the interaction between cysts and nearby structures. The cyst was surgically removed, and macroscopic and microscopic histopathological examinations confirmed the diagnosis of muscular hydatidosis.

Bone echinococcosis with hip localization: A case report with evaluation of imaging features

Hydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus. Bone echinococcosis is rare, accounting for 0.5% to 4% of all echinococcosis. We describe a particular case of pelvic echinoccosis. A 29-year-old man initially presents with pain in his left hip for several years. After an accidental fall from a tree, he suffered a fracture of the left acetabulum. X-rays and CT scans showed an osteolytic area of the acetabulum with bony cortical interruption. MR imaging demonstrated extensive area of osteostructural alteration of the iliac wing and the left acetabulum due to multiple cysts with enhancement of the walls after administration of Gadolinium-based contrast agents. A CT-guided biopsy of an osteolytic area was performed with diagnosis of echinococcus cyst. He underwent albendazole therapy and subsequently echinococcus cyst exeresis, bone curettage, and left hip arthroplasty. Twenty-two months after surgery, CT scan showed recurrence of disease. After 4 years and 6 months of chronic therapy CT scan showed an increase in size of the cyst at the site of the disease recurrence. Five years and 4 months after the first operation, a new cyst exeresis and pelvic bone curettage with implant retention was performed. This case report demonstrates that hydatid cysts should be considered as a possible cause for non-specific pelvic pain, especially in endemic locations.

Primary intraosseous mandibular hydatid cyst: A case report and review of 97 cases of osseous cystic echinococcosis

OBJECTIVE

In this study, we review the reported cases of hydatid disease of the bone in terms of etiology, pathogenesis, and histopathologic, serologic, and radiographic features and management of the disease.

STUDY DESIGN

The present case study reports an extremely rare occurrence of intraosseous hydatid cysts in the orofacial region, wherein symptoms or signs of systemic hydatid disease were absent. We discuss the challenges encountered during the diagnosis and treatment of osseous hydatidosis and reviewed articles on osseous hydatidosis, including 97 cases. We also compare the aspects reported in previous cases of mandibular hydatid cyst with those of the present case.

RESULTS

Hydatid cysts were found to be present in almost every bone of the skeleton in patients (mean age of 39.95 ± 19.67 years; range, 3-76 years). A slight male preference (58.8%) was observed. A history of rural lifestyle, animal bites, and trauma in the affected bone was reported. Only 5 reports on mandibular bone have been published previously, of which 3 were primary.

CONCLUSION

Because of the lack of usual presentations and radiographic features, the presence of hydatid cysts in unusual anatomic locations makes differential diagnosis difficult. The potential risk of anaphylactic shock in susceptible individuals, high recurrence rate, and risk of secondary hydatidosis pose diagnostic and surgical challenges.

Perineal and right femoral hydatid cyst in a female with regional paresthesia: a rare case report

Background

Hydatid cyst is a zoonotic disease caused by the parasite Echinococcus granulosus. The tapeworm larvae can create cyst in different areas of the body, especially the liver and lungs; however, the formation of the cyst in the perineal and femoral regions are very rare. The unusual location of the cyst can help us with the differential diagnosis of soft tissue mass(es) in this location, especially in endemic areas. Diagnosis of this disease is crucial because if the cysts are ruptured during surgery, the fluid inside can cause anaphylactic shock.

Case presentation

Our case is a 55-year-old woman with the chief complaint of a painful mass in the right thigh and perineal area with progressed pain and paresthesia to the right thigh and shin. The patient had no history of fever, abdominal pain, digestive dysfunctions, or chest pain. The vital signs were normal, and there was no family history. Physical examination showed that the skin over the mass had no discoloration, and the size was around 5.7 cm long. The result of the ultrasonography examination showed a cystic mass with suspicion toward the femoral hernia. After a CT scan, the result of secondary workups was a multi-lobular cystic mass with no connection to the abdominal region, which suggested a hydatid cyst. The patient underwent spinal anesthesia and surgery, a cystic mass with ecto- and endocyst, with clinical similarity to a hydatid cyst, was removed with wide margins, and the cyst wall was kept intact. In the next step, the specimen was sent for histological examination that confirmed cystic hydatidosis. The Post-surgical Abdominal and thoracic Ultrasonography screening were used to exclude relapse, and medical therapy was given for 3–6 months. An 18-months follow-up demonstrated no reoccurrence and no newly formed cyst.

Conclusions

Although rare, femoral hydatid cyst can occur in some cases, especially in endemic areas. We highly recommend our colleagues consider ruling out cystic hydatidosis in any patients complaining of regional mass(es), mostly painless, presenting with adjacent tissue compression with or without manifestation of an allergic reaction.

Unusual intramuscular locations as a first presentation of hydatid cyst disease in children: a report of two cases

Background

Hydatid disease is an endemic disease in many countries of the world including the Middle East. It mainly affects the liver and lungs. Intramuscular hydatid disease is rarely reported in children. Such uncommon localization of hydatid cyst may pose difficulties in the clinical and radiological diagnosis; hence affecting patient’s management and outcome even in endemic areas.

Case presentation

We herein describe intramuscular hydatid cysts in 2 different children. The first case is a 5-year-old boy who presented with a painless palpable lump over the right lumbar paraspinal region. His history was remarkable for sheep contact. His laboratory results revealed a mild increase in white blood cell (WBC) count and C-reactive protein. The lesion showed typical features of a hydatid cyst on ultrasound. Further imaging including ultrasound of the abdomen and CT of the chest, abdomen, and pelvis showed infestation of the liver and lung as well. The lesions were resected surgically without complications. The patient received Albendazole preoperatively and after surgery for 3 months. No evidence of recurrence was seen during follow-up.

The second case is a 6-year-old girl who presented with an incidental palpable lump in her left thigh during her hospital admission for recurrent meningitis. Ultrasound and MRI imaging were performed demonstrating a unilocular cystic lesion in the left proximal rectus femoris muscle. A provisional diagnosis of hematoma vs. myxoma was given. Biopsy was performed and yielded blood products only. The lesion was resected surgically with a postoperative diagnosis of hydatid cyst. Blood tests performed afterward showed a positive titer for Echinococcus. The patient received Albendazole for 3 months. No evidence of recurrence was seen during follow-up.

Conclusions

Despite its rarity; skeletal muscle hydatid cyst should always be considered in the differential diagnosis of cystic muscle lesions in children in endemic areas even if imaging studies did not show any of the typical signs. This will improve patient outcome by preventing unnecessary cystic puncture which might lead to serious complications, such as anaphylaxis and local dissemination.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-021-02843-5.

Primary Paraspinal Hydatid Cyst in a Patient Presenting with Low Back Pain: A Case Report

CASE

A 54-year-old man presented with low back pain and low-grade fever. Palpation revealed a focal mass of the lumbar region. Radiographs were normal, but magnetic resonance imaging demonstrated a multicystic mass at the level of L2-L4. The initial diagnosis of a hydatid cyst was confirmed after surgical excision.

CONCLUSION

Although primary paraspinal hydatidosis is rare, physicians should be aware of it when dealing with patients suffering from low back pain combined with red-flag symptoms. Especially in rural regions or areas where populations live in close proximity to host animals, primary paraspinal hydatidosis should be included in the differential diagnosis.

Evaluation of imaging features of pelvic echinococcosis based on multimodal images

Background

Hydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus, It is mainly prevalent in pastoral areas. Bone echinococcosis is rare, accounting for 0.5 to 4.0% of all echinococcosis. It is likely to miss the diagnosis and misdiagnose due to non-specific early symptoms and the clinical manifestations and imaging features. The clinical data of 15 patients with pelvic cystic echinococcosis were analyzed retrospectively, and the X-ray, CT, and MRI imaging features of the disease were discussed, which are reported below.

Methods

All 15 patients underwent CT scan evaluation. A total of 8 patients underwent coronal, sagittal, and three-dimensional reconstruction with 3-mm-slice thickness, and 4 patients underwent X-ray plain film examination. Five cases underwent MRI scan. Eight cases underwent MRI or CT enhanced scan.

Results

X-ray plain film is characterized by continuous cystic bone destruction, irregular low-density shadow when invading soft tissue, and sometimes calcification which can be seen on the wall or inside the cyst. The involved sacroiliac joint or hip joint may narrow or disappear. The involvement of pelvic cystic echinococcosis is relatively wide, and 80% of patients with pelvic cysts in this group had multiple lesions in the same period. Cystic expansive bone destruction was the most common. Pelvic CT revealed a lobulated hypodense lesion of varying size with internal septae, causing cortical thinning and destruction. Most of them had no periosteal reaction. The iliopsoas muscle is most easily invaded. Single cystic echinococcosis of pelvis showed intermediate or low signal intensity on T1-weighted images and hyperintensity on T2-weighted images in the involved bone and surrounding soft tissue on MRI, and the cyst wall showed linear low signal in T1WI, T2WI, and STIR sequences. The polycystic type is characterized by multiple cysts of varying signal intensity (daughter cysts) within a larger cyst is the typical MRI finding, forming “small vesicles” high signal daughter cysts. Osteosclerosis or calcification showed low signal in T1WI and T2WI.

Conclusions

The results of this study suggest that the lesions of pelvic cystic echinococcosis are mostly cystic expansive and osteolytic bone destruction, which is easy to invade the surrounding soft tissue, often accompanied with calcification; among them, multiple cystic lesions are characteristic.

Hydatid cyst of the foot: a case report

Background

Hydatid cyst is rarely located in soft tissues. This case of a hydatid cyst over the plantar surface of our patient’s foot is one of the rarest presentations.

Case presentation

This is a case report of a 22-year-old Somali who presented with a lump over the plantar surface of his foot of 1-year duration. The diagnosis of hydatid cyst was made intraoperatively from the typical appearance of a hydatid cyst. The cyst was completely excised. No local recurrence has been detected to date.

Conclusions

The rare location and uncommon incidence made the initial diagnosis of hydatid cyst of the foot difficult. Detection of the typical germinal membrane can guide the diagnosis of hydatid cyst in rare locations that are found incidentally.

Pelvic Bone Hydatidosis: A Dangerous Crippling Disease

Hydatid disease is one of the most complicated and devastating conditions caused by Echinococcus granulosus. This globally distributed disease continues to be an important public health concern in many low- and middle-income countries. The liver and the lungs are the most frequently involved sites, but virtually any organ system can be affected. Osseous hydatidosis is relatively less common, but it is extremely debilitating and difficult to manage due to frequent recurrences. Patients often demonstrate a delayed clinical presentation as bone involvement is predominantly a silent and slowly progressive disease with a long latent period. Radiological investigations play an important role in the diagnosis. Although standard therapeutic guidelines are not available, the treatment of choice is a combination of chemotherapy and surgery. Clinicians should perform a lifelong follow-up for early detection of potential recurrence and sequels. This paper aims to highlight hydatid disease of the pelvic bone as an important differential diagnosis of tubercular hip arthritis, especially in areas with high echinococcosis prevalence. 

Cystic lesion of pectoralis minor muscle: learning from mistakes

Hydatidosis is a frequent infestation in large endemic areas, caused by helminths. Primary localization within the muscle or bone tissues is rare. We report the case of a 52-year-old woman with a cystic lesion located in the right pectoralis minor muscle, who was initially diagnosed with cystic lymphangioma by imaging examination. She was submitted for surgical treatment; in block resection of the tumor along with the involved muscle was performed. The histopathological diagnosis was of hydatid cyst. The contribution of the ancillary lab tests is analyzed for a precise preoperative diagnostic approach. This case well illustrates that the most likely is not always what it appears to be. Facing of a cystic lesion in the lungs, liver or muscle, clinicians should always think on hydatid disease, particularly in endemic areas.

Hydatid cyst involving Right Pectoralis Major Muscle: A case report

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Hydatid cyst is fairly common in endemic areas & can involve any part of the body.

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Involvement of Pectoralis major muscle is rare.

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Ultrasound and CT scan help in diagnosing them.

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Most of the times, surgery is the usual treatment modality, followed by irrigation with a scolicidal agent.

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A course of albendazole should be prescribed after surgery.

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Hydatid cyst is fairly common in endemic areas & can involve any part of the body.

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Involvement of Pectoralis major muscle is rare.

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Ultrasound and CT scan help in diagnosing them.

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Most of the times, surgery is the usual treatment modality, followed by irrigation with a scolicidal agent.

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A course of albendazole should be prescribed after surgery.

Background and aim

Hydatid disease is caused by Echinococcus granulosus; a tapeworm. They rarely affect the musculoskeletal system of the body (<5% of cases). The objective of this case report is to discuss about hydatid cyst disease involving the right pectoralis major muscle.

Case presentation

Herein, we report a case of a 35 years old lady who came to the outpatient department with a gradually increasing soft swelling at the right upper chest below the clavicle. The final diagnosis was made with the help of a CT scan. The cyst was excised and the area was washed with a scolicidal agent. There was no recurrence after six months of follow up and the patient was doing well.

Conclusion

Hydatid cyst of the Pectoralis Major is rare and must be considered in the differential of any muscular swelling in the body in endemic areas. These cysts should be treated with enucleation/excicion followed by irrigation of the area with a scolicidal agent.

Report of a Hydatid Cyst Case with Biceps Brachii Involvement

Muscular hydatid cyst is a rare condition mainly secondary to the cysts from other organs. We hereby present an uncommon case of primary hydatid cyst found in the right biceps brachii muscle of a 36-year-old male. Magnetic resonance revealed no Echinococcus involvement in any other part of his body. Chest X-ray was normal, and no trace of cyst was found in the lung. In areas where echinococcosis is endemic, any tumor or mass in any part of the patient's body should be evaluated and examined for Echinococcus infestation. This paper is the second case report article on echinococcal biceps brachii infestation existing to this date.

Presentation Patterns, Diagnostic Modalities, Management Strategies, and Clinical Outcomes in Patients with Hydatid Disease of the Pelvic Bone: A Comparative Review of 31 Cases

Hydatid disease is a parasitic zoonosis commonly caused by Echinococcus granulosus. It characteristically involves the liver and the lungs but rare occurrences in other organs have also been reported. Bone involvement is distinctly uncommon, which is predominantly a silent and slowly progressive disease with a long latent period. We conducted a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases. After a comprehensive review of the search results, a total of 31 cases of hydatid disease of the pelvic bone fulfilled the inclusion criteria. The data on patient demographics, epidemiology, lesion site, management, clinical outcomes, and follow-up were collected and analyzed. This review illustrates that hydatid disease should be considered among the differential diagnoses of unusual cystic lesions of the pelvic bone. Prompt diagnosis and appropriate management are of paramount importance to prevent bone destruction and serious complications in these patients. Long-term follow-up should be performed for potential recurrence.

Primary hydatidosis of distal femur masquerading malignancy -A rare case

Hydatidosis is relatively uncommon entity and it rarely affects bone and joints. A rare case of primary hydatidosis (Echhinococcus granulosus infection) involving the distal femur and the knee joint in a 53 years old female is reported here. This presented as a pathological supracondylar fracture of femur. On establishment of a clinical diagnosis she was treated preoperatively with Albendazole 600 mg, daily for 3 cycles each of 21 days with a gap of 1 weeks between cycles. Two stage surgery was carried out, the first being a meticulous debridement and second a total knee replacement with cemented tumor mega-prosthesis. Postoperatively the wound healed completely without any evidence of infection and albendazole therapy was continued for three months following surgery. During the follow-up period of two and a half year, no recurrence of hydatidosis was noticed.

Primary paraspinal lumbar hydatid disease: A known diagnosis in an unusual localization

Hydatid disease is a parasitic infection caused by Echinococcus granulosus. Although the liver and lung are the most common sites of hydatid disease, it can also be seen in other organs due to migration via systemic circulation. Paraspinal lumbar hydatid disease without the involvement of other organs is extremely rare. We aimed to present the imaging and histopathological findings of a case with painful lumbar swelling that was later diagnosed as primary lumbar paraspinal hydatid disease. Hydatid disease should be considered as the differential diagnosis in patients with a lumbar paraspinal mass, particularly that containing multiple well-defined, round, small cysts, and in patients living in or traveling to endemic regions.

Primary hydatid cyst in the posterior thigh, and its percutaneous treatment

Hydatid cyst (echinococcosis) is an endemic parasitic disease, usually encountered in those dealing with agriculture and livestock. The most frequently affected organs are the liver and the lungs. The disease is very rarely encountered in soft tissues. Diagnosing a soft-tissue hydatid cyst may be challenging unless the mass possesses the characteristic features of a hydatid cyst. Soft-tissue hydatid cysts may be treated percutaneously, just like those encountered in the liver. In this case report, we present the radiological findings and modified percutaneous aspiration-injection-reaspiration (PAIR) treatment of a hydatid cyst located in the posterior aspect of the thigh.

Adductor magnus muscle primary hydatid cyst rare unusual site: A case report

INTRODUCTION

The preferred localization of human echinococcosis is the liver and lungs, which account for 85% of cases. Primary musculoskeletal hydatidosis are seldom reported in literature and their incidence is unknown. Primary solitary intramuscular hydatid disease is rare, even in countries in which echinococcosis is endemic and accounts for 1% of all human echinococcosis sites.

CASE PRESENTATION

37-year-old male farmer presented with primary hydatid cyst of the upper medial side of right thigh (Inside adductor magnus muscle) who was managed successfully by preoperative and postoperative dual treatment of albendazole together with surgery.

DISCUSSION

This site of localization has not been reported previously. It is essential to establish definitive preoperative diagnosis of skeletal muscle hydatid cysts. This contraindicates certain treatment options like marginal excision or incisional biopsy due to the likelihood of dissemination and anaphylactic shock on spillage. Pericystectomy remains treatment of choice in musculoskeletal hydatid cysts.

CONCLUSION

Hydatid disease should be included in the differential diagnosis of muscular masses, regardless of its location, especially in endemic areas.

Hydatid cysts in trapezius muscles: A narrative review

Aims:

A hydatid cyst is an endemic parasitic disease that can be formed anywhere in the body, including muscles (3–5% of cases). The cyst can be misdiagnosed in early stages with muscular trigger points. Needling is the popular physical therapy approach in trigger point treatments. Misuse in needling can cause punctures in hydatid cysts and lead to death. The aim of this study was to summarise the available evidence on the manifestation of hydatid cysts in the trapezius muscle.

Methods:

A search was conducted for any reports of differential diagnosis or misdiagnosis of hydatid cysts and trigger points. Computerised literature searches were performed among publications between 1950 and December 2015 using the following databases: PubMed, Science Direct, SCOPUS, Ovid MEDLINE, CINAHL, Cochrane, and AMED.

Results:

Only three studies met the inclusion criteria. All three patients were females under 30 and all three had undergone surgery; two received medical treatment. No misdiagnosis with trigger points was reported and consequently there was no case of needling misuse in hydatid cysts either. However, it does not imply the absence of any clinical case.

Conclusions:

The current study intends to remind the importance of an accurate diagnosis before using needling as a trigger point treatment.

Successful percutaneous treatment of extrahepatic cystic echinococcosis through PAIR and single puncture catheter techniques

PURPOSE

To demonstrate the successful percutaneous treatment of extrahepatic cystic echinococcosis as an alternative to surgical procedures.

MATERIALS AND METHODS

A total of 27 extrahepatic hydatid cysts in 12 patients, the spleen in 8 patients, muscles and soft tissues in 3 patients each and right adrenal gland in 1 patient were treated with PAIR (puncture, aspiration, injection, respiration) or single puncture catheterization methods. As a scolicidal and sclerosing agent, alcohol was used in all patients.

RESULTS

Of 27 extrahepatic lesions of hydatid cysts, 24 (88.9%) were Gharbi type 1 (WHO CE 1), and 3 (11.1%) were Gharbi type 2 (WHO CE 3A). Of hydatid cystic lesions, 20 with PAIR and 7 with single puncture catheterization methods were treated. No major complications developed in any patients. Abscesses were detected in two patients (16.6%). Mean total hospital stay was calculated between 1 and 14 days (mean 2.3 days). Follow-up periods ranged between 10 and 62 months (mean 22.3 months).

CONCLUSION

Percutaneous treatment for extrahepatic hydatid cystic lesions is an important alternative to surgical procedures because of the high therapeutic success rate, lower rate of complications and shorter hospital stays.

Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation

INTRODUCTION

Hydatid cysts are rarely detected in muscle tissue (0.7-0.9%), even in endemic countries. The aim of this study was to present information regarding the clinical manifestations, diagnosis, and management of muscle echinococcosis.

METHODS

Twenty-two patients with hydatid cysts in the muscle were followed from January 2006 through December 2014.

RESULTS

Twenty-four sites of muscle involvement were observed in the 22 patients. Fifteen (68%) of our patients were women, while seven (32%) were men. The mean age was 28.1 ± 15.4 (6-61) years. The most frequent locations were the thigh (27.2%) and the paravertebral region (13.6%). Most patients reported a painless slow-growing mass with normal overlying skin. Most (90.2%) cases were treated by surgical excision and fine-needle aspiration.

CONCLUSIONS

Primary muscle hydatid cyst should be considered in the differential diagnosis in cystic masses of the muscular system without pain and localized enlargement of soft tissue, especially in endemic areas. Hydatid cyst should be investigated using serological tests and imaging modalities. If possible, total surgical excision of hydatid cyst in the muscle should be performed.

Eradication of advanced pelvic hydatid bone disease after limb salvage surgery - 5-year follow-up: a case report

INTRODUCTION

Echinococcosis is produced by the larval stage of Echinococcus granulosus; it is a parasitic disease which is seen rarely in humans and has adverse outcomes. We report a case of advanced pelvic hydatid bone disease with successful limb salvage surgery. Our patient had a 5-year follow-up without recurrence which is a rarity as per the literature. Early diagnosis and prompt medical therapy are necessary for effective management whereas delayed diagnosis is always fraught with the risk of recurrence and sepsis.

CASE PRESENTATION

In 2009, a 30-year-old woman, native of Karachi (Sindhi ethnicity), presented at our clinic with history of a pathological fracture 11 years earlier. Her fracture was initially misdiagnosed and fixed. Subsequently she had persistent disease that progressed with time. Following this she underwent multiple surgeries and the diagnosis of hydatid disease was made but despite multiple debridements and medical therapy she was not cured and finally she was offered a hemipelvectomy (limb sacrifice). On presentation to our hospital she was counseled regarding options of hemipelvectomy versus a limb salvage form of modified internal hemipelvectomy and wide margin resection. She opted for limb salvage. She underwent internal hemipelvectomy with wide margin resection of soft tissue and proximal femur along with postoperative albendazole therapy. She was able to walk again after a very long period. Currently she is 5-years postreconstructive surgery. She is infection free and ambulant without support.

CONCLUSIONS

Hydatid bone disease is a rare entity in our part of the world but a careful history and thorough look at the initial images of our patient would have led to the suspicion of pathologic fracture and subsequent early diagnosis of this difficult problem. A second important learning point in this case was the lack of early referral to a center where this difficult problem could have been handled effectively. This could have minimized the physical, mental and financial stress to the patient and her family.

An unusual cause of mass localized on vastus lateralis muscle in childhood: Hydatid cyst

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Musculoskeletal hydatid cyst is usually associated with involvement of other solid organs.

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Echinococcus can mimic a tumor as mass in the muscle.

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The muscle is considered an unfavorable site for hydatidosis.

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Hydatid cyst should be kept in mind when observing soft tissue mass of the extremities in patients from areas endemic of Echinococcus granulosus.

Introduction

Musculoskeletal hydatid disease is a rare pathology and its diagnosis is often delayed because of slowly growing mass without inflammation. It is critical to suspicious clinical diagnosis in rural endemic areas and for preoperative diagnosis of this disease.

Presentation of case

We present a 9-year-old boy referred with mass located on the anterolateral part of distal thigh. Diagnosis was verified with MRI histopathologically for the presence of hydatid cyst located in vastus lateralis muscle. Magnetic resonance imaging (MRI) was performed for further imaging. MRI showed an oval cystic mass approximately 77 × 20 × 18 mm in the left vastus lateralis muscle, containing round-shaped daughter cysts. Patients were treated with surgical excision and medical therapy. Clinical, radiological and serologic tests showed no recurrence after treatment.

Discussion

The muscle is considered an unfavorable site for hydatidosis because of its high lactic acid level that creates an unfavorable milieu for growth. The detachment of the germinative membrane from pericyst (water–lily sign) is considered to be pathognomonic and is reported in locations other than the liver and lung in magnetic resonance imaging. Surgery is the most effective way to treat hydatid cysts. Complete surgical resection and medical therapy are the preferred treatment for isolated echinococcosis.

Conclusion

Hydatid cyst in vastus lateralis is a very rare disease. Hydatid cyst should be kept in mind when observing soft tissue mass of the extremities in patients from areas endemic of Echinococcus granulosus.

Treatment experiences of pelvic bone hydatidosis

BACKGROUND

Hydatid diseases of the pelvic bone are rare, generally incurable, and have high rates of recurrence.

METHODS

We report nine cases of osseous hydatidosis involving the pelvis. Patients were treated through different surgical options, including simple debridement, bone cement filling with or without internal fixation, reconstruction using a pedicle screw-rod system, and hemipelvic replantation after liquid nitrogen devitalization combined with femoral prosthesis replacement. The therapy was completed by medical treatment or radiotherapy.

RESULTS

The average follow-up was 7.3 years (range 2-19 years). Whilst five patients were symptom-free at the last follow-up, the remaining patients suffered from hip pain or productive sinuses.

CONCLUSIONS

Patients must be treated at the early stages of the disease. Total exeresis and individual reconstruction is necessary when osseous and soft tissue involvement is not extensive. Internal fixation should not be used when surgical eradication is uncertain.

Isolated musculoskeletal hydatid disease: diagnosis on fine needle aspiration and cell block

Hydatidosis is a zoonotic infection caused by Echinococcus granulosus. The most common sites of involvement are liver and lungs. Isolated musculoskeletal hydatidosis in absence of visceral involvement is rare and it mimics bone or soft tissue neoplasm. Fine needle aspiration cytology and cell block aids in diagnosis in such unusual location. Here we present one such rare case of isolated musculoskeletal hydatidosis diagnosed on fine needle aspiration cytology and cell block which was mimicking as fibrous dysplasia on radiology.

Imaging of ruptured endocyst in an isolated intramuscular hydatid cyst--the Scroll appearance

The present article reports a case of a 21 years male that was diagnosed to have isolated intramuscular hydatid cyst of the biceps brachii on Ultrasound and MRI. The 'Scroll appearance' of the ruptured endocyst in this case is likely to be an intervening transient stage in evolution of the disease and also indicates recent rupture of the endocyst.

Infected primary paraspinal hydatidosis with water lily sign

BACKGROUND

Primary muscular hydatidosis is extremely rare, and the diagnosis of the infected muscular hydatid cyst can be difficult due to atypical clinical and radiological findings.

CASE REPORT

We present herein an interesting case of a 24-year-old man with primary infected muscular hydatid cyst located in the paraspinal muscles eroding the right lamina of C6 vertebra that was diagnosed with water lily sign on computed tomography.

CONCLUSION

Water lily sign is a pathognomonic imaging finding for hydatidosis, and defined when free-floating endocyst is seen. Cyst hydatid should always be considered in the differential diagnosis of any soft tissue mass of the patients from endemic regions.

Composite treatment for primary long-bone hydatidosis

Hydatid disease is a parasitic tapeworm infection caused by the Echinococcus species. Involvement of the long tubular bones is rare in hydatid bone disease. Patients are initially asymptomatic and usually present at a later stage of the disease when the bony lesions are extensive. Diagnosing bone hydatid disease is challenging, even in endemic regions, and a high index of suspicion is required because the radiologic findings often mimic other bone pathologies. Recurrence following treatment can occur after a long period of quiescence.This article describes a case of hydatid disease in a 62-year-old woman with extensive diaphyseal tibial involvement. She was treated with initial chemotherapy followed by extended curettage, polymethylmethacrylate cementation, and intramedullary fixation. Functional outcome was excellent, with no recurrence at 60-month follow-up. She was fully weight bearing with no pain or discomfort and had full hip, knee, and ankle range of motion.This case was important due to its rarity, the diagnostic challenge it presented, and the composite nature of the treatment used to avoid recurrence. Diaphyseal bone hydatidosis can be initially treated like a low-grade malignant tumor with curettage and high-speed burring, followed by filling the defect with polymethylmethacrylate cement. The composite treatment of chemotherapy with the surgical protocol described offers a reasonable chance of long-term disease suppression. Recurrent disease can be treated with repeat curettage and cementation. Wide excision with reconstruction of the resulting defect should only be considered for recalcitrant diaphyseal hydatid disease.

Hydatidosis of the pelvic bone: case report and review of the literature

The authors report three cases of pelvic bone hydatidosis: two men and a woman aged from 25 to 42 years. The lesions were extensive: In two cases, they extended to the entire hemipelvis, and in one case, the extension was to the sacrum, which makes it difficult to carry out a radical surgery. In two cases, computed tomography was evocative and allowed for the completion of a local and precise checkup for a patient through MRI. At the therapeutic level, the first patient was treated by curettage and sterilization with oxygenated water followed by medical treatment, but with recurrence few months later. The second patient was put only under medical treatment because of the extent of the lesions, allowing therefore for clinical and radiological stabilization. Concerning the last patient, she benefitted from the resection of the femoral head and the right iliac wing followed by a medical treatment. The evolution was favorable with a three-year recession. The actual treatment of the osseous echinococcosis would be a combination of albendazole and surgery.

Treatment of chronic osteomyelitis secondary to hydatid disease of bone using gentamycin beads

Hydatid disease of bone is rare. It remains asymptomatic over a long period. It is usually detected after a pathological fracture or secondary infection or following the onset of compressive myelopathy in cases of vertebral lesions. Secondary infection of hydatid disease of bone could be difficult to treat. The authors present a case of chronic osteomyelitis of the proximal aspect of the left femur in a 37-year-old male patient secondary to hydatid disease of bone. It was treated by aggressive debridement, gentamycin beads, and bone graft to fill the defect. No recurrence of the hydatid lesion or infection was detected after 2 years. This case showed that in addition to aggressive debridement, gentamycin beads may be valuable in eradicating the infection in such a case.

Gluteal region musculoskeletal hydatid cyst: Case report and review of literature

Hydatid disease is a parasitic infestation of humans and herbivorous animals, caused by Echinococcu granulosus. Dogs and some wild carnivores, like foxes, are definitive hosts, harboring worms in their intestines. Musculoskeletal cysts account for 0.7-3% of total cases of hydatidosis. Primarymuscular hydatidosis without involving the thoracic or abdominal organs is extremely rare. Intramuscular infestation may mimic a soft tissue tumor leading to inappropriate cyst rupture with the attendant risks of anaphylaxis and dissemination to other organs. So preoperative evaluation is critical to avoid lifethreatening complications. We report a case of 34-year-old male patient with a cystic gluteal swelling turning out to be hydatid cyst on surgical exploration. Surgical excision with a pharmacology complementary treatment with antihelementhics is necessary to achieve the complete healing.

Hydatid embolism from a thoracic aortic pseudoaneurysm presenting as gangrenous toes

Cystic echinococcosis (hydatid cyst), caused by Echinococcus granulosus, has worldwide distribution and poses a health problem in endemic areas. Embolization of hydatid cysts into the vascular tree is an unusual manifestation of the disease. The hydatid embolism results from spontaneous or traumatic rupture of the cyst, and rare case reports of this kind are not well documented in the literature. We report a case of a hydatid embolism from a ruptured hydatid in a pseudoaneurysm of the thoracic aorta. A 45-year-old woman presented with gangrenous changes of the toes of her right foot. After embolectomy, the histopathology of the embolus was doubtful about its being blood clots around hydatid membranes. Postoperatively, computed tomography (CT) of the chest revealed a pseudoaneurysm of the descending thoracic aorta. Definitive surgery for the pseudoaneurysm was done during a second operation. Numerous hydatid cysts were evacuated from the pseudoaneurysm. This report emphasizes the need for an early diagnosis and treatment of echinococcosis before disabling and life-threatening complications occur.

Solitary hydatid cyst of the thigh: a challenging diagnosis

A 53-year-old woman presented with an enlarging mass in the medial aspect of her right thigh. Magnetic resonance imaging suggested an intramuscular hydatid cyst. The cyst was surgically excised. Although muscular hydatidinosis is rare, its resemblance to soft tissue tumors warrants careful diagnosis since any invasive diagnostic measures may lead to fatal complications.

Revision hip replacement for recurrent Hydatid disease of the pelvis: a case report and review of the literature

A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis.

Primary vertebral echinococcosis: four cases reports and review of literature

Primary vertebral echinococcosis has been considered to be a hypothetical and exceptional possibility. It affects bones in 1% of reported cases. Spine is involved in 45-50% of these. The disease preferentially affects the thoracic spine. It begins as a single primary cyst containing daughter cysts. We report four cases of primary vertebral echinococcosis, extending into the extradural space without any other primary site of infection. We conclude that primary vertebral echinococcosis, although rare should be considered in destructive lesions of the vertebrae and spine in regions that the disease is endemic. Advanced imaging studies should be performed to diagnose the disease. Early decompressive surgery of the spine, with chemotherapy, is the treatment of choice for these patients.

Pelvic bone and hip joint hydatid disease revealing a retroperitoneal location

Echinococcosis is a parasitic disease produced by the larval stage of Echinococcus granulosus. Hydatid disease of bone is rarely seen in humans and it has been reported in only 1-2% of cases of echinococcosis. We present a patient who developed hydatid disease of the left pelvic and femoral bones with cartilage destruction of the ipsilateral hip joint revealing a retroperitoneal location of hydatid cyst. Hydatid bone must be present in the differential diagnosis of chronic monoarthritis. Skeletal involvement is usually secondary to visceral hydatidosis that we must research. Early diagnosis allows eradication and salvage of the bone and the hip joint. Delayed diagnosis is always fraught with the risk of recurrence and sepsis.

[Echinococcosis of the rib with epidural extension]

Osseous hydatidosis, especially when located in the rib, is a very rare disease. Less than 50 cases of costal echinococcosis have been reported in the literature to date. The authors report a case of echinococcosis of the rib with epidural extension in a 76-year-old patient presenting paraparesis. In addition, the patient presented a large posterior and thoracic soft tissue mass measuring about 30 centimetres in diameter. A chest x-ray, a CT thoracic scan and an MRI of the dorsal spine were performed. The imaging suggested echinococcosis of the rib with epidural extension. The cyst was completely resected. Histopathology of the resected specimen confirmed the diagnosis of echinococcosis. The patient died due to postoperative complications. Accurate presurgical diagnosis allows for appropriate management and helps eradicate the disease. This also prevents the dissemination of parasites and further complications.

Extensive hydatidosis of the femur and pelvis with pathological fracture: a case report

BACKGROUND

Hydatid cysts caused by Echinococcus sp can produce tissue cysts anywhere in the body. Skeletal cystic lesions are rare, yet because of their unusual presentation diagnosis can be missed.

CASE REPORT

We report a case of extensive hydatidosis of the femur with pathological fracture and involvement of the pelvis bone, without involvement of abdominal viscera, in a 51-year-old woman. The patient presented with swelling and deformity of the upper and middle third of the left thigh. The diagnosis was confirmed clinico-radiologically and the patient was treated with hindquarter amputation and chemotherapy. The patient died of sepsis and extensive bedsores one month after surgery.

CONCLUSIONS

Orthopedic surgeons should be alert to this morbid condition and this disease should be suspected in cystic lesions affecting any organ of the body in pathological fractures with non-union, especially in endemic areas of the world. Early diagnosis helps in eradication and salvage of the bone; misdiagnosis and delayed diagnosis are always fraught with the danger of amputation, recurrence, and sepsis.

Primary hydatid cyst of skeletal muscle affecting the knee: a case report

Hydatid disease is a parasitic infection generally occurring in specific geographical areas. Exclusive involvement of the muscles is extremely uncommon, because implantation at this site would require passage through the filters of the liver and lung. We describe a patient with a mass in the popliteal fossa of the knee for 7 years who was seen for pain and was found to have hydatid disease.