Unusual location of hydatid cysts: a case report and literature review

Isolated muscle involvement in hydatid cyst

Although hydatid cyst, caused by Echinococcus granulosus, can develop in any part of the body, involvement of the liver and lung represents approximately 90% of all cases. Involvement of the musculoskeletal system is comparatively rare. Diagnosis is difficult because symptoms are non-specific. We present a case, together with the imaging findings, in order to draw attention to the exclusion of hydatid cyst before surgery or biopsy in patients with muscular pain and a palpable mass.

Primary axillary hydatid cyst: A case report

BACKGROUND

Hydatid disease, also known as echinococcosis, is an endemic parasitic infection, most commonly caused by Echinococcus granulosus. It may affect any organ resulting in the formation of hydatid cysts, but most frequently involves liver and lungs. Hydatid cyst arising primarily from axilla is an extremely rare manifestation of this condition, with only a few cases reported in medical literature.

CASE PRESENTATION

Here we present the case of a 32-year-old Indian male farmer, who presented with a painless, slow-growing mass in the left axillary region of 8 months duration. Preoperative imaging led us to the diagnosis of primary axillary hydatid cyst, with no other associated cysts or masses anywhere else in the body. Following antihelmintic therapy, the cyst was surgically excised without rupture. The diagnosis was further confirmed by macroscopic and histopathological examination.

CONCLUSION

This case report highlights the importance of considering hydatid cyst in the differential diagnosis of palpable masses in the axillary region, especially in regions where the disease is endemic. Early recognition and accurate diagnosis are crucial for appropriate management and optimal patient outcomes.

A rare presentation of hydatid cyst disease at the thigh: a case report from Syria

Introduction and importance

Hydatid cyst disease is a zoonotic disease caused by Echinococcus granulosus and is recognized as a significant health issue in many countries, particularly Mediterranean countries. Hydatid cysts in the musculoskeletal system are rare, with only a few reported cases. These usually occur as secondary cysts resulting from the hematogenous dissemination from primary sites.

Case presentation

This paper reports a case of a 77-year-old man with a mass in his thigh that had been increasing dramatically in size for 4 months with no signs of local inflammation, fever, or any other symptoms. Findings from an MRI were consistent with a large abscess, so a true-cut biopsy was taken before referral. A pathological study after surgery revealed the lesion was a hydatid cyst, and a previously performed biopsy caused a rupture of the cyst.

Clinical discussion

Misdiagnosing hydatid cysts, especially in non-usual areas, may lead to an unwelcome biopsy and consequences.

Conclusion

This case report highlights the importance of considering hydatid cysts when encountering any enlarging mass, regardless of its location or rate of growth.

Treatment of a Large Gluteal Hydatid Cyst in Syria Using a Manual Negative Pressure Wound Therapy Device (PragmaVAC)

The lungs and liver are the most common sites of hydatid cysts, but they may also be found in other organs. We report the case of a lady in her 50s who presented to a hospital in northwest Syria with a large swelling in the right gluteal region. This was diagnosed as a gluteal abscess, and an incision and drainage were performed. Intraoperatively, a hydatid cyst germinal membrane was noted. She had the required imaging to exclude other cysts, which revealed a liver hydatid cyst of 7.5 cm, which was treated with PAIR (puncture, aspiration, injection, and re-aspiration) and albendazole. The residual wound was closed using a manual vacuum-assisted closure (VAC) pump for seven days. A key lesson is that a hydatid cyst in the gluteal muscles, though rare, should be considered in the differential diagnosis. We also show that the innovative use of a manual VAC pump can be used to support closure of large hydatid cyst cavities in muscles.

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.

Unusual site of echinococcosis: axillary hydatid cyst—a case report

Background

Echinococcosis is a multisystem disease that might affect all organs, especially the liver and the lungs among adults. Axillary hydatid cyst, an extremely uncommon disease, was rarely reported in the literature. We report herein a case of axillary hydatid cyst which revealed a disseminated hydatid disease among a previously healthy woman.

Case presentation

A previously healthy woman, aged 53 years old, presented with a painful mass in her right axillary region. Physical examination revealed a painful semi-mobile right axillary mass, of 12 cm in size. Thoracoabdominal computed tomography scan revealed numerous cystic lesions: right axillary, pulmonary, hepatic, pancreatic, splenic and intraperitoneal lesions. The diagnosis of disseminated hydatid disease was suspected in front of the cystic lesions and the positive serology result for hydatid disease. An excisional biopsy of the axillary mass lesion was performed, confirming the diagnosis of a hydatid cyst. The patient received albendazole after hospital discharge.

Conclusions

Although axillary hydatid cyst is an extremely uncommon disease, the diagnosis should be rule out in front of the presence of a mass in the axillary region. Imaging results associated with serological tests might suspect the diagnosis, which can only be confirmed with parasitological or/and histopathological examination. Its management include surgical and medical therapy.

Liver hydatidosis disease with portal vein invasion: Report of a rare case and review of literature

Hydatid disease is a zoonosis caused by Echinococcus granulosus. Humans are aberrant intermediate hosts and following the infection, the parasite may infest any organ of the body, with the liver and lungs being the most involved organs. Portal vein involvement by hydatid cyst disease is extremely rare with only seven cases published to our knowledge. We present a 62-year-old Persian male with an incidental liver cyst. His laboratory tests were in normal ranges. The ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) findings show hydatid disease of the liver with distal portal vein involvement and collateral venous formations. The patient is being followed and has not gone under surgery yet. It possesses a propensity to invade multiple organ systems, notably the liver and lungs. Hydatid disease is imposing a significant burden on healthcare systems specifically in developing countries. Manifestations of the disease are often non-specific, while a subset of the infected population remains asymptomatic. Portal vein invasion and obstruction is a rare complication, and it is important to distinguish it from vein thrombosis, as the management of these entities requires different approaches.

Primary hydatid cyst of the left-sided colon presenting with lower gastrointestinal bleeding; an extremely rare location of extrahepatic hydatid disease

Hydatid cyst is an endemic disease especially in underdeveloped and developing countries, affecting mostly the liver and lungs. However, a wide range of unusual anatomical sites in the abdomen have been reported, including the spleen, pancreas, kidney, and ovaries as well as dissemination within the abdominal and pelvic cavities. The location of hydatid disease in the colon is very infrequent, and very few cases have been presented so far. The hydatid cysts located in other sites are mostly due to rupture or extrusion of primary liver or splenic cysts. In this article, we present a case of primary left-sided colon hydatid cyst, resected laparoscopically with the affected intestinal segment. The diagnosis of hydatid cyst was made by macroscopic and microscopic examinations.

A validated method to identify Echinococcus granulosus sensu lato at species level

The zoonotic tapeworm Echinococcus granulosus sensu lato (s.l.) represents a species complex encompassing multiple causative agents of cystic echinococcosis, a neglected tropical disease affecting more than one million people in the world. At least eight genotypes, grouped in five species, are currently recognized within this species complex, and they differ in terms of relative public health impact. Here we present a molecular method that first identifies the common E. granulosus sensu stricto (s.s.) (genotypes G1 and G3) based on a PCR-RFLP assay, and can further identify the remaining species based on a multiplex PCR assay. We demonstrate the applicability of the method to DNA extracted from parasitic cyst material of human and animal origin, preserved in ethanol or frozen. The method has been developed and validated at the European Union Reference Laboratory for Parasites (EURLP), according to the ISO/IE 17025.

Uncommon Locations of Cystic Echinococcosis: A Report of 46 Cases from Southern Iran

Background

Most cases of hydatid cysts form in the liver and lung and other tissues are considered as unusual locations in hydatid cysts. The current study aimed to find out the rate and features of hydatid cysts in uncommon locations in Fars Province, Southern Iran, over a 15-year period.

Methods

The hospital records of patients who underwent surgery for hydatid cysts in university-affiliated hospitals in Fars Province, Southern Iran, from 2004 to 2018, were retrospectively reviewed. For each patient, clinical and demographical data were recorded.

Results

During a 15-year period, a total of 501 patients were surgically treated for hydatid cysts, and out of these, 46 (9.2%) were presented with the unusual locations of hydatid disease. Males constituted 28 (60.9%) of these patients while 18 (39.1%) of the patients were females. The patients' age ranged from 5 to 80 years (mean = 40.49; SD = 20.37). The size of the cysts ranged from 2 to 20 cm (mean = 8.69, SD = 4.59). The most common unusual location for the hydatid cyst was the spleen with 30.4% of cases, followed by the pelvic cavity (15.2%). Out of 46 cases with unusual location of the hydatid cyst, 10 (21.7%) cases had lung, 22 (47.8%) cases had liver, and 5 (10.9%) cases had both liver and lung hydatid cysts, simultaneously with cysts in unusual locations.

Conclusion

In cystic echinococcosis- (CE) endemic areas, hydatid disease can affect any organ, from head to toe, in humans. The disease should be considered in the differential diagnosis of any cystic entities anywhere in the body.

Hydatid disease of the liver with portal vein invasion mimicking portal vein thrombosis

Hydatid cyst disease is a zoonosis caused by the parasite Echinococcus. It may infest any organ of the body, but it most frequently involves the liver, lungs, and nervous system. Portal vein involvement by hydatid cyst disease is extremely rare with only five cases published in the English literature to our knowledge. We present the ultrasonography (US) and computed tomography (CT) findings of a 77-year-old male with hydatid disease of the liver with portal vein invasion mimicking portal vein thrombosis. Colour Doppler US confirmed the lack of blood flow within the portal vein and stigmata of cavernomatosis. CT clearly demonstrated a communication between the multiloculated lesion and the portal vein and the multiple daughter vesicles obstructing the portal vein. The consideration of this complication will make it possible to distinguish this entity from portal vein thrombosis and, thus, the management of the patients with hydatid cyst disease particulary in endemic regions.

Laparoscopic cystectomy for pancreatic echinococcosis: A case report and literature review

Cystic echinococcosis (CE) is a widely endemic helminthic disease caused by infection with the Echinococcus granulosus tapeworm. Following ingestion of eggs, hydatid cysts develop, most frequently in the liver and lungs, but occasionally in other organs. Infection of the pancreas by hydatid cysts is very rare, even in endemic areas. Most cases of pancreatic hydatid cysts reported in the literature were treated surgically using traditional open laparotomy. There are only few case reports describing laparoscopic treatment for this disease. Herein, we report on an eighteen-year-old female patient who was referred to our institution with a hydated pancreatic tail cyst. After a course of treatment with Albendazole, we successfully performed laparoscopic splenic-sparing distal pancreatectomy to remove the cyst with an uneventful intra- and post-operative course.

Primary hydatid disease of the axilla presenting as a cystic mass

Hydatid cysts is most often characterized by hepatic and pulmonary involvement, but it also rarely involves other body parts and systems. Axillary involvement by hydatid cysts is considerably rare in countries with endemic hydatid cyst manifestation, and cases from countries like Turkey are still widely reported. A young woman aged 24 years was seen at our clinic for a painful axillary mass. She was detected by a thoracoabdominal tomographic examination to have a localized multilocular cystic mass in her left axillary region; the mass showed little soft tissue invasion at its periphery but no hepatic or pulmonary involvement at all. It was excised from its stalks and totally removed. The diagnosis of hydatid cyst was made by macroscopic and microscopic examination. It was highlighted by this case report that the differential diagnosis of palpable masses in axillary region should include hydatid cyst, particularly in areas where the disease is endemic.

Uncommon localizations of hydatid cyst. Review of the literature

INTRODUCTION

Hydatid disease is an endemic anthropozoonosis with usual localization in liver and lungs. Rarely it localizes in uncommon sites as spleen, skeleton, kidney, brain, cardiac muscle, peritoneum, sub cutis. Complications of uncommon localizations are the same that for usual ones.

MATERIAL AND METHODS

Review of the literature on rare and atypical localization of hydatid cysts in soft tissues. Key-words used on Pub-Med [(echinococ OR hydatid) AND (soft tissue OR subcutaneous OR cutaneous)] without time limit. There were found 282 articles; 242 were excluded because of muscular or bone localizations. 40 were coherent.

RESULTS

Different variables are taken into account: age, sex, geographic area, anatomic localization of the cyst, dimension, symptoms, signs, mobility, blood exams and specific serological tests, imaging techniques for diagnosis, existing of septa in the structure, treatment, anaesthesia, spillage, neo-adjuvant and adjuvant treatment, follow-up period, recurrent lesions.

CONCLUSION

It would be useful create an homogeneous and standardized collection of data of these rare and potentially life-threatening conditions in order to create guide-line of diagnostic and therapeutic process and create (or adopt) unique classification of the lesions.

Role of chemotherapeutic agents in the management of cystic echinococcosis

Hydatid disease is caused by infection with the metacestode stage of Echinococcus tapeworms of the family Taeniidae. The primary carriers are dogs and wolves, and humans are accidental hosts that do not contribute to the normal life cycle of this organism. The liver is the most commonly involved organ in the body by cystic echinococcosis (CE) secondary to infection with Echinococcus granulosus . Management options for CE should depend on the World Health Organization (WHO) diagnostic classification. Small (<5 cm) WHO stage CE1 and CE3a cysts may be primarily treated with benzimidazoles; the first-choice drug is albendazole. In some situations the combination of albendazole and praziquantel may be preferred. Chemotherapy with a benzimidazole or albendazole plus praziquantel is also used as adjunctive treatment to surgery and percutaneous treatment. Drug treatments have been the indispensable therapeutic modalities for cystic echinococcosis.

Coexistent axillary hydatid disease and tuberculosis: Case report of an extremely rare occurrence

Tuberculous infection is highly prevalent in India, however, hydatid disease is relatively uncommon. Frequent sites of predilection of hydatid disease are the liver and lungs. Other unusual sites of infliction are the peritoneum, thyroid, breast, pancreas, and mediastinum. Hydatid disease in the axilla is quite uncommon. We hereby report a case of coexistent axillary hydatid disease with tuberculous lymphadenitis. To the best of our knowledge, even after extensive search of the literature we did not come across any such case. Fine needle aspiration cytology (FNAC) is a cost-effective procedure performed on an outpatient basis and helped clinch a prompt diagnosis, with minimum discomfort or complications. The role of FNAC in early diagnosis cannot be overemphasized.