Percutaneous Treatment of Bone Hydatid Cyst

Cystic echinococcosis (CE) may be encountered in almost every site of the body, but bone involvement is relatively rare. The vertebral column and pelvis are the most affected areas. The combined medical and surgical approach is the main treatment option in current literature. Although percutaneous treatment of CE cysts located in the liver, spleen, kidney, and soft tissues has become a serious alternative to surgery, there is no bone CE cyst treated percutaneously in the literature. This case report aims to point out that percutaneous treatment can be an effective treatment choice and alternative to surgery.

Pelvic echinococcosis presenting as a mass in the gluteal region: a case report

Hydatid disease of the skeletal system is a rare entity. We present one such case of pelvic echinococcosis in a 62-year-old male who presented with the chief complaints of pain and swelling in the left gluteal region for the past twelve years. The patient was planned for and underwent en-bloc excision of the lesion. Albendazole was used pre- and post-operatively to reduce parasitic load. At the last follow-up, the patient was disease-free and able to carry out his daily activities without much difficulty. We would conclude that, although uncommon, echinococcosis should always be ruled out, especially when dealing with other indolent pathologies of the hip joint.

Osseous cystic echinococcosis: A case series study at a referral unit in Spain

Background

Cystic echinococcosis (CE) is present in all continents, except for the Antarctica. Characteristically, CE lesions are found in the liver and the lungs, but virtually any part of the body may be affected (the spleen, kidneys, heart, central nervous system, bones, among others). It is estimated that the incidence of bone involvement in CE is 0.5% to 4%.

Methodology

A retrospective study was performed of patients with osseous CE treated at the National Reference Unit of Tropical Diseases of the Ramon y Cajal Hospital, Madrid, Spain, between 1989 and December 2017. Epidemiological, clinical, diagnostic and therapeutic data of patients with long-term follow-up were collected.

Main findings

During the study period, of the 104 patients with CE, 27 exhibited bone involvement (26%). The bones most frequently affected were the spine, followed by the ribs, pelvis, femur, tibia and the scapula. The most common symptom was pain followed by medullar syndrome and pathologic fracture. In total, 81.5% of patients underwent surgery for osseous CE at least once. As many as 96% received albendazol either in (mostly long-term) monotherapy or in combination with praziquantel.

Conclusions

The diagnosis and management of osseous CE is challenging. In many cases osseous CE should be considered a chronic disease and should be managed on a case-by-case basis. Lifelong follow-up should be performed for potential recurrence and sequels.

Echinococcosis occurs in humans as a result of infection by a cestodes of the genus Echinococcus. One of the species, E. granulosus, causes cystic echinococcosis (CE) in humans worldwide. In the lifecycle there is a definitive host (generally dogs) which host this parasites at the small bowel. From there, ground is shed with the eggs of the parasite through feces and the intermediate host (usually a sheep or other herbivores get infected). Humans act as an incidental intermediate host when they become infected through the consumption of water or food contaminated with Echinococcus eggs. Once the egg has been ingested, it penetrates the intestinal mucosa and through the circulatory system finds an anatomical site forming a cystic lesion (hydatid or hydatid cyst). Characteristically, CE are found in the liver and the lungs, but virtually any part of the body may be affected. Incidence of osseous CE is low, its diagnosis and management is challenging and there is little information published. In this study we report our experience at a referral unit during nearly 30 years in the management of a series of patients with osseous CE. Such information may be useful for other physicians when treating osseous CE.

[Bone hydatidosis: report of five patients and review of the literature]

Bone location of hydatid cysts occurs in 0.5 to 3% of all cases of hydatidosis. The most common bones involved are spine, long bones and pelvis. We report five patients with bone hydatidosis. A 24-year-old male consulting for paraparesis and numbness of lower limbs; CAT scan showed hydatid cysts located in D2, D3 and D4 vertebral bodies. A 47-year-old male consulting for a fracture of the femur; X rays disclosed multiple hydatid cysts in the femur. A 13-year-old female consulting for claudication of the right lower limb; X ray examination showed a hydatid cyst in the iliac bone. A 21-year-old women presenting with weakness of the lower limbs and voiding problems; CAT scan showed a vertebral hydatidosis and spinal cord compression. A 67-year-old female presenting with weakness of the lower limb and loss of sphincter control; CAT scan showed hydatid cysts in D4 vertebral body.

Bone hydatid disease refractory to nitazoxanide treatment

We report a patient with bone hydatid disease that was refractory to both long-term daily treatment with albendazole, combined with cimetidine or administered as monotherapy ( approximately 15 years) and a relatively short course of nitazoxanide combined with albendazole (3 months). Despite continuous daily medical treatment, bone invasion and destruction proceeded. His pain and disability progressively increased.

[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.

[Primary hydatidosis of the chest wall. Report of 5 cases]

BACKGROUND

Hydatidosis is an endemic affection in Tunisia. Bone echinococcosis is a relatively rare entity accounting for only 0.5-2% of all hydatid cysts in humans and chest wall is an uncommon site for the disease.

AIM

Report of a new case

CASE

We report about this talk 5 cases concerning 2 men and 3 women (mean of age 35.4 years) explored for parietal mass (4 cases), or chest pain (1 case). Diagnosis was suspected on radiologic findings in all cases. All patients underwent surgery. Medical treatment was associated in 2 cases. Histopathology of resected specimen confirmed diagnosis of echinococcosis. No recurrence was observed during follow-up period.

A varied presentation of hydatid cyst: a report of four cases with review of literature

Contrary to the popular perception, hydatosis does not remain restricted to certain geographical locales but is a global health concern, particularly in the rural countryside. Although liver and lung involvement account for the majority of the lesions, primary breast, bone, kidney and soft tissue hydatosis with features of cystic echinococcosis are extremely rare. We report four such rare cases of cystic echinococcosis which were diagnosed and treated in our institute.

Case report: Echinococcus disease of the bone presenting as a femoral shaft nonunion

Osseous hydatidosis (Echinococcus infection) is a rare parasitic bone infection that poses challenges in diagnosis and treatment. We present a novel case of osseous hydatidosis of the femoral shaft that was diagnosed at the time of surgery for a recalcitrant femoral shaft nonunion. We know of no reports of osseous hydatidosis presenting as a femoral shaft nonunion. A discussion of the challenges in diagnosis and treatment of osseous hydatidosis are discussed, and the literature on osseous hydatidosis is reviewed.

[Hydatid disease of bone: a report of 2 cases]

INTRODUCTION

The hydatid cyst of Echinococcus granulosus tends to develop in liver. The primary bone hydatidosis is rare. EXEGISIS: The authors report 2 cases of primary hydatidosis of bone in a 57 year old men and 60 year old diabetic women. The symptoms and signs were not specific. The ultrasound investigation: standard radiography and computed tomographic scan, was suggestive of the lesion. The chest radiograph and the abdominal ultrasound were normal. Serological tests for hydatid disease were positive. The two patients have surgical excision and medical treatment: Albendazole administrated for 6 months. Histologic evidence confirmed the diagnosis. The outcome was good for both patients without recurrence after 2 years.

CONCLUSION

Through these 2 cases and a review of the literature, the authors analyse the epidemiological and clinical aspects of bone hydatidosis and discuss the therapeutic procedures.

A case of pelvic bone hydatidosis--diagnosis and treatment

INTRODUCTION

Echinococcosis is a frequent helminthiasis in Bulgaria. Hydatid cysts commonly affect the liver and the lung. Echinococcosis rarely involves bones (0.5 to 2.5%) and vertebral column is affected in 50% of the cases.

PATIENTS AND METHODS

We report a case of a 67-year-old female with echinococcosis of the pelvic bone clinically manifested by pain and swelling of the right iliac region and complicated by abscess of the surrounding soft tissue. The patient underwent surgery at the Department of Orthopedics and Traumatology, University hospital "St. George", Medical University, Plovdiv. Diagnosis was based on imaging findings, serologic and histological methods. Biopsy material was investigated by standard histological methods hematoxilin-eosin (H-E),PAS and hydrargyrum impregnation after Gommori, which presented both chitin and germinative membranes of the hydatid cyst.

RESULTS

The patient underwent complete resection of the bone lesion along with the surrounding soft tissue. Purulent collection of 1200 ml was evacuated. A six months follow-up of the patient revealed no pathology of the cyst and other organs. She walked unaided. No echinococcosis recurrence was observed on control examinations.

CONCLUSIONS

Hydatid bone disease is usually difficult to diagnose. Its treatment includes excision of bone lesion, curettage and oral therapy. It is not always possible to fully remove all the affected bone fragments especially when cysts are located in the femoral and pelvic bones. In the reported case the hydatid cyst was fully removed by resection of the right iliac ala and the patient's mobility was preserved.

Hydatid bone disease: a case report and review of the literature

Hydatid disease may develop in almost any part of the body and can be identified with a combination of clinical history, imaging findings, and serologic results; however, the diagnosis of bone hydatidosis is primarily based on radiographic findings. Bone hydatid disease is often asymptomatic, and its diagnosis is usually made at an advanced stage when lesions have become extensive. We present a case of a 45-year-old woman who was admitted to the University Hospital, Stara Zagora, Bulgaria complaining of pain in her left tibia. Radiographs revealed an oval cyst with a diameter of 3.5 cm, located in the diaphyseal part of the tibia. The cyst was excised, and no recurrence was observed on follow-up. Functional outcome was excellent.

Cytological diagnosis of rhinosporidiosis with skeletal involvement--a case report

A young Hindu male presented with painful swelling of left lower thigh for 6 months. The provisional diagnosis both clinically and radiologically was osteosarcoma. FNAC and biopsy proved the lesion to be a case of rhinosporidiosis. The present case is reported due to rare incidence of skeletal rhinosporidiosis.

[Costo-vertebral hydatid disease: the role of MRI]

INTRODUCTION

Hydatid disease of bone is very rare accounting for 0.5% - 3% of all localisations.

CASE REPORT

We report the case of a woman of 30 years who presented with posterior chest pain. The chest radiograph showed an extra-pulmonary mass associated with a lytic rib lesion. Thoracic ultrasound revealed a multiloculated soft tissue and fluid mass. CT scan showed a fluid filled costo-vertebral cyst. MRI identified extension into the spinal canal. Pathological examination of the surgically resected material confirmed the diagnosis.

CONCLUSIONS

This observation emphasises the role of MRI in assessing the extent of hydatid cysts of the posterior chest wall and in particular invasion of the spinal canal.

Extraspinal bone hydatidosis

BACKGROUND

Bone hydatidosis caused by the tapeworm larva, Echinococcus granulosis, is rare. Extraspinal locations are even rarer. We report our experience with the treatment of twenty-six patients with extraspinal osseous hydatidosis.

METHODS

Between 1972 and 1998, we treated twenty-six patients with extraspinal hydatidosis. There were sixteen men and ten women, with a mean age of 51.5 years. The mean duration of follow-up was 12.8 years. The infected area was the ilium in four patients, the ilium and sacral ala in two, the ilium and hip in eight, the femoral head and the acetabular roof in five, the femoral shaft in one, the distal part of the femur in one, the femoral head in one, the scapula in two, and the ribs in two. All patients were treated with curettage or wide resection. Chemotherapy was used in all but five patients.

RESULTS

Nineteen patients (73%) were free of disease at the time of the last follow-up. Repeated curettage or wide resection was necessary in nine of these patients; it was required in three of the nine because of surgical wound infection and in six because of recurrence. Of the seven patients who were not free of disease at the time of the last follow-up, six had persistent chronic productive sinuses and one had a chronic wound infection. The cases involving both the ilium and the hip were the most difficult to treat. Radical surgery is difficult in this location, and numerous surgical procedures were always required.

CONCLUSIONS

The results of treatment of osseous hydatidosis are satisfactory only in locations where complete and wide excision is possible. In the pelvis and hip, where radical surgery is almost impossible, the results are disappointing.

Using a custom mega prosthesis to treat hydatidosis of bone: a report of 3 cases

Three cases of hydatidosis of bone with pathological fracture were treated by wide resection, custom mega prosthesis replacement, and chemotherapy. Two patients were females and one was male, with a mean age of 47 years (range, 38-55 years). Two of them had a pathological fracture of the proximal femur, and one had a pathological fracture of the distal femur. All patients were treated postoperatively with albendazole 400 mg, twice daily, for 12 weeks. During the mean follow-up period of 4.5 years, no recurrence of Echinococcal infection was noticed. The use of the custom mega prosthesis technique has not been reported elsewhere, and hydatid disease of the bone can now be considered an extended indication for custom mega prosthesis in addition to its application in surgery for tumours and massive trauma.

Multilocular echinococcosis in humerus: a case report

Hydatid cysts caused by E. multilocularis are less common than those caused by E. granulosus (Pintilie et al., 1996). Infection in the bones is rare, accounts to 0.9-2% of all hydatid cysts (Wirbel et al., 1997). A thirty-five-year old female was presented with a four month history of pain and swelling in her humerus. Plain radiography (Fig. 1) and ultrasonography revealed partial destruction of bone. Laboratory investigations revealed Hb, 15.2 gm, ESR, 11 1st hr and WBC, 10,000. Indirect haemagglutination test using hydatid antigen was positive (1/16,000) and ELISA (IgG) was positive (1/4096). Lung, liver and brain scans were normal. Endosteal-sarcoma was considered and a biopsy was performed. Histopathological examination of bone tissue, showed many cysts (Fig. 11). On surgical operation, a huge number of cysts were found, and removed. The patient was given Albendazole in the recommended dose (Mazyad et al., 1998), and followed up. Six months later, all symptoms and signs regressed. Again three months more, the serological levels markedly decreased and X ray was normal.

Multilocated hydatid cysts involving the liver, the spleen and the scapula

A 75-year-old healthy woman presented with mild, right hypochondral discomfort and heaviness present for at least 2 days before admission to the hospital. She also complained of pain in the region of her left shoulder, which was moderate in nature and of approximately 1 year's duration. Shoulder pain had led to the limited use of her left arm. The patient had a history of intimate contact with sheep and dogs. Clinical examination revealed a tender, enlarged liver (5 cm below the right costal margin), as well as a tender scapula on palpation. Laboratory tests showed the white blood cell count to be 7000/mm3 with 8% eosinophils. The erythrocyte sedimentation rate was 30 mm per hour. Serological tests for Echinococcus granulosus, which included immunoelectrophoresis and indirect immunohaemagglutination assay, were strongly positive (IHA 1/800).

A plain abdominal radiograph showed the enlarged hepatic shadow and a curvilinear calcification lying within it (Figure 1). An ultrasound study was then performed to further characterize the lesion. A hyperechoic band located in the right lobe of the liver associated with an acoustical shadow representing dense calcification was found (Figure 2). Two roundish, hypoechoic areas located in the enlarged spleen were found incidentally during the ultrasound examination of the abdomen (Figure 3). The diagnosis of splenic hydatid disease was favoured because of the simultaneous presence of the cystic lesion in the liver. The roentgenographic examination of the left scapula showed multiple, variously sized, round or oval osteolytic lesions, giving a honeycomb appearance of the inferior part of the scapula (Figure 4).

On the basis of clinicoradiological features and laboratory findings a diagnosis of hydatid disease was proposed. A thorough clinical, radiological and ultrasonographic search did not reveal any other sites of hydatid cysts. The patient proceeded to surgery where she underwent local hepatic resection, splenectomy and local total excision with a wide healthy margin in the scapula. Histological examination of the material excised from the liver, the spleen and the scapula confirmed the diagnosis of hydatid disease. The patient made an uneventful postoperative recovery and was discharged 1 week later. Pain subsided totally following surgery. At follow-up examination 6 and 12 months later, the patient remained asymptomatic, and had no clinical or radiological evidence of the disease in the primary sites or elsewhere.

The use of polymethylmethacrylate in the management of hydatid disease of bone

Hydatid disease of bone is rare. It probably represents between 0.5% and 4% of all human hydatid disease and, in about 60% of patients, affects the spine or pelvis. Between 1986 and 1998, we treated 15 cases of bone hydatidosis. Curettage, swabbing with povidone iodine and filling the defect with polymethylmethacrylate (PMMA) were carried out in ten patients. Three of these had a recurrence after five years, but seven had no signs of relapse during a mean follow-up of 52 months. We believe that the combination of antihelminthic therapy, wide resection and the use of PMMA gives the best outcome in the treatment of bone hydatidosis.

Humeral hydatid cyst complicated with extraosseous involvement: a case of unusual location of echinococcosis

Hydatid disease is a parasitic disease most commonly caused by Echinococcus granulosus that seldom involves the skeleton and is still common in the countries of the temperate zones. We present an extremely rare case report of a young patient with humeral hydatid disease complicated with extraosseous involvement. Plain film of the left humerus demonstrated distortion of the axis, regional expansion of the humeral shaft with minimal thinning areas of the cortex. Additionally, numerous radiolucent areas of the humeral shaft were observed especially at the distal part of the bone. No calcification of the soft tissues was noticed. Computed tomography examination showed significant destruction of the trabecular bone of the humeral head and polycystic appearance of the bone marrow with regional calcifications into the lumen. Additionally, a large cystic lesion between medial and lateral head of the triceps muscle with some foci of calcifications were observed. Magnetic resonance imaging revealed the multiocular nature of the lesion into the humeral lumen with a cystic lesion involving the soft tissues of the upper arm. The cyst showed contrast enhancement at the pericyst capsule of the cyst after Gadolinium-DTPA administration.

Hydatid cyst of bone: diagnosis and treatment

Osseous hydatidosis is a rare occurrence of hydatid disease. Anatomoclinical changes are, however, peculiar to this localization. From the anatomopathologic standpoint, this localization marks the torpid, insidious progression of the parasite into bone tissue, leading to an immediate diffuse, extensive, invasion process, so complete surgical eradication is rarely possible. From the clinical standpoint, whatever the localization may be, we are surprised by the latency of this affection, the patient being treated at an advanced stage, when radiologic lesions are already extensive, and the complications, especially in the spinal area, are severe. Owing to the poor biologic findings, the diagnosis of osseous hydatidosis is still primarily based on roentgenographic findings. Sometimes, however, the diagnosis is established only after surgery. Treatment of osseous hydatidosis is closer to oncologic therapy than to the usual surgical treatment of visceral hydatid cysts. Because of the poor results with medical treatment, osseous hydatidosis must be treated by a radical operation with wide excision, adapted to each localization. In the main, the prognosis of osseous hydatidosis remains poor, especially with spinal and pelvic localizations, which are the most frequent ones. The prognosis and treatment of osseous hydatidosis belong in the same category as a locally malignant lesion.

Hydatid disease of rib

Osseous hydatidosis, especially when located in the rib, is a very rare disease. In 1978, only 39 costal echinococcosis cases were published. The course of the disease is generally slow and laboratory tests are frequently negative. Diagnosis is generally made through the combined assessment of clinical, radiologic, and laboratory data. Living in a rural area is an important risk factor for the disease. The gold standard for therapy is radical removal of the involved ribs or chest wall. We present the case of a 63-year-old herdsman with costal echinococcosis and a review of the literature.

[Scapular hydatidosis with extraosseous involvement]

A forty three-year-old female, born in a rural area of southern Chile, at the age of 30 presented pain and limitation of motility of the right shoulder. Later on, she presented an increasing of volume at the right scapular region. A radiography showed an osteolytic lesion of the scapula. In a biopsy an osseous hydatidosis was found and a hydatid cyst was extirpated from the soft tissues. Four years later, as she presented again pain and volume increasing in the same anatomical area, albendazole was given to her, and a CAT practiced revealed osteolytic lesions of the bone, several periosteal ruptures and multiple cysts in the muscles. She was submitted to surgery again in order to extirpate cysts. After two years the patient presented the same clinical manifestations and radiological and CAT images previously observed. In considering all these facts a radical surgery was decided.

MR appearances in a case of femoral ecchinococcosis

Magnetic resonance (MR) findings of a rare case of osseous echinococcosis with involvement of the femur are described. Attention is drawn to the typical MR appearances and therapeutic management.

Assessment of the immunological surveillance value of humoral and lymphocyte assays in severe human cystic echinococcosis

Thirty cystic echinococcosis (CE) patients in Uruguay with severe bone or secondary disseminated echinococcosis were immunologically assessed using cellular (lymphocyte transformation assay, LTA) and humoral (specific antibody and subclass responses, circulating antigen and circulating immune-complexes) immunological assays during the course of chemotherapy (albendazole and/or praziquantel). CE patients were divided into 4 groups, according to clinical treatment and outcome: (I) surgery and chemotherapy, (II) chemotherapy with outcome unchanged, (III) chemotherapy with outcome improved, and (IV) chemotherapy considered cured. Increased circulating antigen was of prognostic value in some severe CE cases where levels remained high and/or increased. The lymphoproliferative response in vitro to Echinococcus granulosus antigen was statistically greater in all patient groups compared to normal individuals but at lower levels in improved or cured CE patients. Levels of non-specific LTA response were significantly lower than controls for all groups during albendazole treatment (P < 0.001) but returned to normal levels in cured patients, a result consistent with parasite-induced suppression of cellular responses. This study suggests that, at least in severe osseous and secondary CE, immunosurveillance by specific antibodies, especially total specific immunoglobulin, was overall of more practical use than antigen-specific in-vitro lymphocyte transformation assays.

Hydatid disease of bones and joints. 8 cases followed for 4-16 years

Hydatid disease is a rare parasitic disease that seldom involves the skeleton. Treatment is difficult because of problems with the preoperative diagnosis, the invasive nature of the bony involvement and the variable anaphylactic reaction to the cyst fluid antigen. We present 8 cases with osseous hydatidosis who were treated over a period of 11 years. The spine was involved in 2 cases, the ilium in 2, the hip in 2, the tibia in 1 and the humerus in 1. We point out that diagnosis is difficult and the prognosis is often poor.

Uncommon locations of hydatid disease: CT appearances

Hydatid disease (HD), already known by Hippocrates, is prevalent and widespread in most sheep-raising countries in Asia, Australia, South America, Near East, and southern Europe. The disease is most commonly due to Echinococcus granulosus and may occur in any organ or tissue. The location is mostly hepatic (75 %) and pulmonary (15 %), and only 10 % occur in the rest of the body [1]. Imaging modalities such as US, CT, and MR imaging are helpful in diagnosing the disease. The reliability of each method depends on the cyst's location in the body [2-5]. The purpose of this essay is to illustrate the use of CT in depicting some unusual locations of HD besides the liver and lung.

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

OBJECTIVE

Our purpose was to describe the morphologic appearance of musculoskeletal lesions in patients with cystic echinococcosis shown by CT and MR imaging.

CONCLUSION

Patients with musculoskeletal lesions of cystic echinococcosis typically have cystic structures in adjacent soft tissues. These cysts morphologically resemble abscesses, with peripheral uptake of contrast medium and variable signal intensities on T1-weighted MR images. The absence of calcifications or endovesicular daughter cysts does not exclude the diagnosis of cystic echinococcosis.

Bone and soft tissue manifestations of alveolar echinococcosis

OBJECTIVE

The present study demonstrates the osseous and soft tissue manifestations of alveolar echinococcosis (AE).

PATIENTS

We report on eight patients with AE with bone or soft tissue involvement confirmed at biopsy or needle cytology.

RESULTS

All eight patients showed hepatic involvement. Four exhibited infiltration of the spine as a result of direct spread of the hepatic primary lesion; distant metastases were observed in only three of these patients. Calcifications, which are typical for hepatic manifestations of the disease, were observed in soft tissue in only two of eight cases (25%); we observed no instances of endovesicular daughter cysts.

CONCLUSIONS

AE manifests itself in the vertebral column as a form of spondylitis and in soft tissue presents similar to an abscess. Since in most of these cases spread of the disease per continuitatem from the liver is present, the diagnosis is easily made from the characteristic hepatic findings.

Infratemporal hydatid cyst--unusual location of echinococcosis

Hydatid disease is an important medical problem in countries of the temperate zones. Only occasional cases are reported in the head and neck region. An unusual location for hydatid disease in the infratemporal fossa is presented. Characteristics of this rare disease together with treatment modalities are discussed.

The value of plain film findings in hydatid disease of bone

The radiographic features of hydatid disease of bone have been reviewed in 16 Kuwaiti patients. The majority of the lesions were in the lower limb or pelvis, and the commonest presentation was with a pathological fracture. The radiological signs seen most often were lucent lesions in the bone, associated with expansion of the bone and thinning of the cortex. In patients with these signs soft tissue calcification appeared to be highly suggestive of hydatid disease. The disease was diagnosed before operation in only half the patients. In areas where the disease is endemic hydatid disease should be suspected when the lesions described are seen on plain films.

Radiographic and computed tomographic findings in hydatid disease of bone

Twenty-six patients with hydatid disease of bone were evaluated by means of radiography and conventional tomography. Fourteen patients underwent high resolution computed tomography (CT). In two patients with vertebral disease, magnetic resonance imaging (MRI) examination was also performed. Seventeen patients underwent surgery with histological examination in all. Based on the surgical data and gross examination of the specimen, the radiographic and CT findings have been reviewed to identify the most characteristic radiographic features and to assess the role of CT. Radiographic finding of hydatidosis are rarely typical in bone, and only in a few patients can CT contribute to the diagnosis. On the other hand, the local extension of the lesion both in bone and in soft tissues, which is essential in planning surgery, is always demonstrated well by CT.

[Extrahepatic echinococcosis: diagnosis and treatment]

Following a review of the diagnostic, evolutive and therapeutic aspects of pulmonary echinococcosis, which is the most frequent hydatid disease after the hepatic one, the authors develop the problems raised by echinococcosis affecting the heart, kidneys, bones and spleen.

The value of computed tomography in osseous hydatid disease (echinococcosis)

The authors report three cases of osseous hydatid disease (echinococcosis) in which examination by computed tomography (CT) was found to be helpful in establishing the diagnosis. Recognition of this rare bone infection in orthodox radiographs is notoriously difficult, but is aided by knowledge of the patient having lived in an area in which the disease is endemic. In two instances, one involving the shoulder and the other the thoracic spine, radiological abnormalities had been attributed at first to tuberculosis. In the third case, in which a destructive lesion in the sacrum had been interpreted correctly, CT studies provided confirmation of a recurrence. CT has proved to be an effective and sensitive method of demonstrating these destructive lesions in bone, of determining their spread, and of establishing the presence of other hydatid cysts in adjacent soft tissues. This technique has been found to be of value in preoperative planning of the surgical approach to hydatid lesions of the skeleton.

Alveolar echinococcosis of the femur

A case of alveolar echinococcosis with involvement of the femur is described. Bone involvement is extremely rare in alveolar echinococcosis. Attention is drawn to the difficulty of diagnosis, and the therapeutic possibilities are discussed.