Hydatid disease of proximal femur treated using a mega prosthesis: A case report

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Bone Hydatidosis has nonspecific clinical and radiological signs.

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These characters may lead to late or misdiagnosis situation.

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Anamnesis is very important, it could guide the diagnosis.

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The diffuse and infiltrative characters of bone hydatidosis make it challenging to manage.

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The reconstruction prosthesis allows extensive resection without damaging the function.

Introduction

Bone hydatidosis is a rare disease. It is characterised by discreet and nonspecific symptomatology that makes the diagnosis late and the treatment difficult to manage.

Presentation of case

We report the case of a 29-year-old woman hospitalised for right hip pain with a lytic image well limited in the upper extremity of the right femur. We retained the diagnosis of a unicameral bone cyst which weakens the cortical bone. Osteosynthesis with a Gamma nailing was indicated to prevent fractures. At five years of follow up, the patient presented a pain recurrence. Radiographs showed almost a destruction of the upper extremity of the femur and a loosening of osteosynthesis material. Thus, we indicated the removal of the osteosynthesis material and a bone biopsy were performed. Histopathological examination leads to an osseous hydatid cyst diagnosis. We decide to carry out a carcinological resection and reconstruction with a mega prosthesis. The clinical results were excellent and no recurrence for three years follow-up.

Discussion

Bone hydatidosis is challenging to diagnose at an early stage, mainly when it simulates a bone cyst. Moreover, the consequence of a late or misdiagnosed bone hydatidosis is devastating. Because of its diffuse and infiltrative character, it gradually invades the whole bone, which makes it more complicated to manage.

Conclusion

Bone hydatidosis is a rare disease that can simulate other pathologies like a bone cyst in our case. In these situations, the anamnesis has a primordial place to guide the diagnosis and investigations.

[Hydatidosis bone wall chest: About three cases]

INTRODUCTION

Bone hydatidosis of the chest wall is rarely reported in the literature. Costal and sternal location are uncommon. Through 3 observations and literature review, we report particular pathophysiological and diagnostic aspects of costal and sternal hydatidosis. We also discuss therapeutic and prognostic aspects of this disease. OUR CASES: we report the cases of 45, 41 and 17 years old male patients, 2 of them had previous surgery for thoracic wall mass in general surgery service. Clinical presentation was thoracic wall painful mass sticking to bone. One patient had isolated costal location, the 2 others had sternal location; in one of them, the disease is located in sterno-costo-clavicular area. In all 3 cases, the disease was diagnosed by computed tomography (CT) scan, showing bone lysis or mediastinum enlargement. Patients undergo extended bone resection removing away all destructed parts of the bone. After surgery, albendazole has been prescribed to all patients. No recurrence was observed after 12 months follow-up.

CONCLUSION

Chest wall bone hydatidosis is unusual even in endemic regions, with slow evolution and inconspicuous symptoms. Radiology plays a key role in the management of this disease. Extended surgical resection associated with medical treatment (albendazole) is a reliable treatment without recurrence.

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.