Primary Hydatid Cyst of Vastus Lateralis Muscle

Primary extrahepatic hydatid cyst of the thigh, an unusual presentation of sciatica: A case report of a diagnostic challenge

INTRODUCTION

Sciatica, a condition characterized by pain along the sciatic nerve distribution, is commonly associated with nerve compression or irritation. However, its etiology can vary, including rare non-spinal causes such as hydatid cysts. We present a case of hydatid cyst in the thigh causing sciatica-like symptoms, highlighting the diagnostic challenges and management approach.

CASE PRESENTATION

A 40-year-old patient with a history of pulmonary tuberculosis presented with persistent lumbosciatic pain despite conservative treatment. Physical examination revealed left sciatica without spinal abnormalities. MRI revealed a hydatid cyst in the thigh, causing nerve irritation. Surgical resection of the cyst was performed, achieving symptom resolution.

DISCUSSION

Hydatid cysts in skeletal muscles are rare, with atypical presentations complicating diagnosis. Localization in the thigh, particularly the biceps femoris muscle, is uncommon. Diagnostic modalities include imaging and serological tests, while treatment involves surgical excision and postoperative albendazole therapy.

CONCLUSION

Recognition of rare presentations like thigh hydatid cysts causing sciatica-like symptoms is crucial for timely diagnosis and management. This case emphasizes the importance of considering unusual etiologies in refractory sciatica cases and underscores the complexity of medical diagnosis. Increased awareness among healthcare providers can lead to improved patient outcomes and prevent diagnostic delays.

Primary Soft Tissue Hydatid Cysts

OBJECTIVE

Hydatid cyst disease is a helminthic infection caused by Echinococcus granulous, which is encountered with cysts in many organs, especially the liver and lungs. Soft tissue and intramuscular hydatid cyst are rare even in endemic countries. It is challengig to distinguish subcutaneous and intramuscular hydatid cysts from soft tissue tumors. This study aimed to present the clinical features of primary soft tissue hydatid cyst cases without liver and lung hydatid cyst in the Southeast Anatolian region, where hydatid cyst disease is endemic.

METHODS

Patients admitted to the Şanlıurfa Training and Research Hospital General Surgery and Orthopedics and Traumatology Outpatient Clinic between September 2018 and December 2019 with complaints of pain and/or swelling under the skin and soft tissue were evaluated. After the examinations, the records of the patients who were operated on with a pre-diagnosis of hydatid cyst and whose histopathologic evaluation was reported as a hydatid cyst were reviewed retrospectively.

RESULTS

Eight patients were included in the study. The mean age of the patients was 39.75±14.80 years. Lesions were located in neck (12.5%), left thoracic posterior area (25%), gluteus (25%), thigh (12.5%), right upper quadrant of abdominal wall (12.5%), and under the right clavicle (12.5%). When imaging methods were examined, ultrasonography was performed in 7 patients (87.5%), chest computed tomography was performed in 1 patient (12.5%), and magnetic resonance imaging was performed in 2 patients (25%).

CONCLUSION

Diagnosis of hydatid cyst should be considered in the differential diagnosis of soft tissue tumors in countries of endemic regions for hydatid cyst disease such as Southeastern Anatolia Region, Turkey.

Evaluation of radiologic diagnostic criteria and treatment options in skeletal muscle hydatid cysts

AIM

To investigate the diagnosis and treatment methods of soft tissue involvement of hydatid cysts (HCs).

MATERIALS AND METHODS

Eleven patients who were diagnosed as having HC with muscular tissue (soft tissue) involvement between 2010 and 2016 were evaluated retrospectively. Seven patients had typical HC magnetic resonance imaging (MRI) and four patients had cysts with an unusual appearance. We evaluated how to diagnose the cysts using imaging methods, their characteristic radiologic images, and treatment alternatives against the disease. The patients were treated with antihelminthic chemotherapy preoperatively and postoperatively.

RESULTS

Of the 11 patients who underwent treatment, 7 were diagnosed using MRI and 4 were diagnosed with histopathologic examinations. The mean follow-up period was 16 (range, 6-24) months, and the mean age was 39.4 (range, 24-56) years. In seven patients, multivesicular appearance with specific MRI findings, T2-hypointense rim appearance, double-rim sign, membrane dissociation, and appearance of daughter cysts were identified as diagnostic criteria. Two patients underwent ultrasound assisted percutaneous aspiration-injection-reaspiration (PAIR) treatment. Seven patients underwent total pericystectomy, and two patients underwent subtotal pericystectomy with serum saline injection into the cyst. Two patients showed signs of mild anaphylaxis, one during the diagnosis and one during treatment.

CONCLUSION

There may be difficulties in the diagnosis and treatment of HCs of the musculoskeletal system. It should be known that there are alternative methods in the treatment (cyst excision and PAIR treatment). Clinical, serologic, and radiologic findings should be used in the diagnosis. To avoid complications during the histopathologic diagnosis, MRI should be examined in detail. It is thought that atypical cysts can be diagnosed (double-layer appearance and peripheral rim sign) in addition to typical cysts (detached membrane and multivesicular appearance), and diagnosis and treatment can be planned without anaphylactic complications.

Concurrent pulmonary and hepatic hydatid cysts managed with single stage surgery

Most of the case reports on hydatid cyst have documented its diagnosis and treatment involving either lungs or liver. This case report is unique as it documents the standard diagnostic and treatment approach followed for curing concurrent multiple hydatid cysts involving liver and right lung simultaneously via single stage surgery. A 52-year-old male presented with symptoms of simple pneumonia along with mild pain in the right upper quadrant. Hydatid cyst was considered as the differential diagnosis after physical examination. Both CT scan and MRI confirmed the presence of multiple cysts both in the liver as well as right lung. A single stage radical removal of cysts from both the organs was performed. The patient was hemodynamically stable, and no complications were reported postoperatively. This case report highlights the importance of considering hydatid cyst as a differential diagnosis in the light of vague presenting symptoms. Also, it emphasizes on the benefits of single stage surgery for removing cysts from both the organs simultaneously.

Primary infected hydatid cyst of the thigh in a young lady; case report with literature review

Hydatid disease present in certain parts of the world. Infection of the musculoskeletal system occur in less than 0.5%.

A 24-year-old lady had a painful mass in the inner aspect of the right thigh. MRI of the thigh showed a mixed signal intensity lesion measured about 65*100 mm, the mass was related to the muscle and the superficial femoral artery and its cavity had multiple septations.

During surgery an infected hydatid cyst of the muscle was found, evacuation was done with removal of the cyst. The patient was discharged next day and she received anthelminthic medications for 3 months.

Hydatid cyst of the muscles present with gradually enlarging mass or complications such as nerve compression, infection or rupture.

Treatment may be medical using anthelminthic medications. Complete surgical excision is the best surgical option; involvement of other organs should be excluded. Follow-up is recommended.

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Hydatid cysts could affect various body parts causing wide range of clinical presentations.

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Infection is one of the common complications of hydatid cysts.

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Surgery is the main treatment option in most of the cases.

Hydatid cyst of the calf presenting as painless mass: A case report

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Hydatid disease is endemic in certain parts of the globe.

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High index of suspicion is required for the diagnosis of this disease specially in rare anatomical sites like the calf.

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Involvement of other organs must be excluded as the disease may affects many organs simultaneously.

Background

Hydatid disease is a zoonotic disease that is transmitted to the human by ingesting the eggs of the parasite Echinococcus granulosus, it most commonly affects the liver but every organ could be affected, musculoskeletal system involvement occurs in 0.5–4% of patients. Most patients present as soft tissue mass in the affected muscle.

Preoperative diagnosis usually done radiologically by ultrasound or MRI examination.

Case presentation

We present a 60-year-old lady presented with painless mass in the right calf for 2 years.

The mass was soft, non-tender, mobile from side to side. Ultrasound of the mass showed cystic lesion that contained multiple small cysts inside, and the diagnosis of hydatid disease was made before surgery.

During surgery and after opening the mass the lesion appeared to be hydatid cyst containing innumerable daughter cysts. Complete evacuation of the all the daughter cysts done. The patient discharged next day with no postoperative complications.

The patient received postoperative albendazole therapy for 2 months and follow up done 6 months after surgery with no complications.

Conclusion

Hydatid disease should be thought when patients present with mass lesion in any part of the body especially in endemic areas. The most important step in the diagnosis is to exclude the presence of other cysts in other parts of the body.

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.

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.

Case reports of hydatid disease

Two cases of hydatid cyst were reported in the Microbiology department, Siddartha Medical College in 2011. 42 year old female presented with a history of painless swelling in the right inguinal region for 5 years which was insidious in onset and gradually increasing in size. She developed itching prior to the hospital visit. 40 year old male presented with abdominal swelling since 1 year, not associated with vomiting or jaundice. Both the patients were from rural background.

Conclusion. Echinococcus granulosus can cause cystic lesions anywhere in the body. High degree of suspicion of hydatid disease is essential in endemic areas in cystic lesions.

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.