Fractura lineal de cráneo en el lactante con traumatismo craneoencefálico leve: influencia de la tomografía computarizada en su manejo / Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management

INTRODUCCIÓN: El traumatismo craneoencefálico (TCE) constituye un motivo frecuente de consulta en urgencias pediátricas. La necesidad de intervención quirúrgica en pacientes menores de 2 años con TCE leve es mínima, pero los hallazgos intracraneales pueden influir en el manejo del paciente. El objetivo de este trabajo es valorar el impacto de la TC en el manejo de los niños menores de 2 años con TCE leve que presentan una fractura lineal de cráneo en la radiografía convencional. MATERIAL Y MÉTODOS: Estudio descriptivo y retrospectivo en el que se analizan las radiografías de cráneo practicadas a pacientes menores de 2 años que fueron atendidos en el área de urgencias de nuestro hospital de nivel terciario por TCE leve en un período de 4 años. RESULTADOS: Se realizaron 88 exploraciones de tomografía computarizada (TC) realizadas por sospecha de fractura lineal de cráneo en radiografía. Se confirmó la fractura en 74 de ellos (16% de falsos positivos). De los 74 niños con diagnóstico confirmado de fractura, la TC fue normal en el 92% de los estudios y mostró hallazgos intracraneales en 6 casos (8% de los casos con fractura). Dos casos requirieron ingreso superior a 2 días (2,7% de todos los casos con fractura) y en los 4 casos restantes la estancia hospitalaria no superó las 48 horas. En ningún caso se requirió cirugía. CONCLUSIÓN: No parece justificada la realización de una TC craneal de forma sistemática en niños menores de 2 años con TCE y bajo/intermedio riesgo de lesión intracraneal, incluso con fractura lineal de cráneo. En ausencia de factores de riesgo, proponemos individualizar el estudio de imagen basándose en el criterio clínico

INTRODUCTION: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays. MATERIAL AND METHODS: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period. RESULTS: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery. CONCLUSION: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria

Linear skull fracture in infants after mild traumatic brain injury: influence of computed tomography in management. / Fractura lineal de cráneo en el lactante con traumatismo craneoencefálico leve: influencia de la tomografía computarizada en su manejo.

INTRODUCTION: Traumatic brain injury (TBI) is a common reason for pediatric emergency room visits. Surgical intervention for mild TBI is rarely necessary in children aged <2 years, but the intracranial findings can influence the management of the patient. This paper aims to evaluate the impact of computed tomography (CT) in the management of children aged <2 years with mild TBI and linear skull fractures on plain-film X-rays. MATERIAL AND METHODS: This retrospective descriptive study analyzed skull X-rays obtained in children <2 years old attended for mild TBI in the emergency room of our tertiary hospital over a 4-year period. RESULTS: A total of 88 CT studies were done for suspicion of linear skull fractures on plain-film X-rays. Fractures were confirmed in 74, representing a false-positive rate of 16%. Of the 74 infants with confirmed fractures, intracranial CT findings were normal in 68 (92%) and abnormal in 6 (8%). Two patients (2.7% of all patients with confirmed fractures) required hospital stays longer than 2 days; the other four patients with abnormal intracranial findings were discharged within 48hours of admission. None of the cases required surgery. CONCLUSION: Systematic CT studies do not seem justified for all children aged <2 years with TBI and low/intermediate risk of intracranial lesions, even when they have linear skull fractures. In the absence of risk factors, we propose individualizing the imaging study based on clinical criteria.

Valoración del cerebelo fetal mediante resonancia magnética / Evaluation of the fetal cerebellum by magnetic resonance imaging

La valoración del cerebelo fetal debe realizarse siempre por protocolo en las ecografías realizadas durante la gestación. Diferentes motivos como limitaciones técnicas o hallazgos ecográficos poco concluyentes han convertido la sospecha de patología del cerebelo fetal en una de las indicaciones más frecuentes de resonancia magnética (RM) prenatal. Aunque la ecografía fetal es la técnica de imagen de elección para su valoración, la RM muestra con mayor detalle la anatomía de la fosa posterior y las anomalías del desarrollo del cerebelo fetal, lo que permite un diagnóstico prenatal más preciso. Describimos la anatomía normal del cerebelo fetal mediante RM, así como las diferentes patologías que afectan a su normal desarrollo, y revisamos la terminología más apropiada para definirla, su diagnóstico diferencial y el papel de la RM en la evaluación prenatal de la fosa posterior (AU)

Obstetric protocols dictate that the fetal cerebellum should always be assessed during sonograms during pregnancy. For various reasons, including technical limitations or inconclusive sonographic findings, suspicion of cerebellar abnormalities is one of the most common indications for prenatal magnetic resonance imaging (MRI). Although sonography is the imaging technique of choice to assess the cerebellum, MRI shows the anatomy of the posterior fossa and abnormalities in the development of the fetal cerebellum in greater detail and thus enables a more accurate prenatal diagnosis. We describe and illustrate the normal anatomy of the fetal cerebellum on MRI as well as the different diseases that can affect its development. Moreover, we review the most appropriate terminology to define developmental abnormalities, their differential diagnoses, and the role of MRI in the prenatal evaluation of the posterior fossa (AU)

Evaluation of the fetal cerebellum by magnetic resonance imaging. / Valoración del cerebelo fetal mediante resonancia magnética.

Obstetric protocols dictate that the fetal cerebellum should always be assessed during sonograms during pregnancy. For various reasons, including technical limitations or inconclusive sonographic findings, suspicion of cerebellar abnormalities is one of the most common indications for prenatal magnetic resonance imaging (MRI). Although sonography is the imaging technique of choice to assess the cerebellum, MRI shows the anatomy of the posterior fossa and abnormalities in the development of the fetal cerebellum in greater detail and thus enables a more accurate prenatal diagnosis. We describe and illustrate the normal anatomy of the fetal cerebellum on MRI as well as the different diseases that can affect its development. Moreover, we review the most appropriate terminology to define developmental abnormalities, their differential diagnoses, and the role of MRI in the prenatal evaluation of the posterior fossa.

Leucoencefalopatía con afectación de troncoencéfalo y médula espinal y elevación de lactato: presentación de 2 nuevos casos / Leucoencephalopathy with brain stem and spinal cord involvement and lactate elevation: report of two new cases

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Estridor congénito crónico: ¿qué hacer, cuándo y por quién? / Chronic congenital stridor: what should be done, when, and by whom?

Se presenta un lactante con estridor congénito crónico y síntomas asociados que motivaron el estudio etiológico del mismo. La demora en la realización de la endoscopia respiratoria completa y el sesgo que la experiencia de los especialistas inicialmente consultados introdujo en la interpretación de los hallazgos radiológicos determinaron un diagnóstico incompleto y un manejo no terapéutico. La fibrobroncoscopia demostró laringomalacia, traqueomalacia y compresión traqueal extrínseca. La angio TC identificó la arteria innominada como causante de la compresión. Tras la evaluación por un equipo multidisciplinar se recomendó realizar una aortopexia que resultó curativa (AU)

A case of an infant with congenital chronic stridor and the etiological studies performed because of associated symptoms is presented. Diagnosis was incomplete and initial management was conservative due to the delayed complete flexible endoscopy of the respiratory tract and the limited experience of the specialists who were consulted. Endoscopy revealed laryngomalacia, tracheomalacia and extrinsic tracheal compression, which was due to innominate artery as angioCT revealed. Aortopexy, recommended by a multidisciplinary team, was curative (AU)

[Intracranial lipomas in paediatrics: a retrospective study of 20 patients]. / Lipomas intracraneales en pediatría: estudio retrospectivo de 20 pacientes.

INTRODUCTION: Intracranial lipomas (ICL) are congenital malformations that are due to an anomalous differentiation of the primitive meninges. AIMS: The purpose of this study is to determine the most frequent symptoms related to ICL in the paediatric age, as well as to evaluate whether they are directly related to their location and to their association with other brain malformations. PATIENTS AND METHODS: A retrospective clinico-radiological study was conducted involving 20 paediatric patients diagnosed as suffering from ICL between 1985 and 2003 at three hospitals in the Valencian Community. RESULTS: 70% of the cases were females and the average age when ICL was diagnosed was 5.3 years (interval from 2 months to 13 years). The most common initial clinical justification for the neuroradiological study was psychomotor retardation in eight patients (40%) and persistent, predominantly migrainous, headaches in six of them (30%). Only one patient was examined because of epilepsy. The prevailing site was the interhemispheric fissure in 10 patients (50%), followed by the quadrigeminal cistern in five (25%) and the mamillary body infundibulum axis in three of them (15%). One case was located in the cerebellum and another was found in the lateral ventricle, with involvement of the choroid fissure. Associated anomalies were observed in eight patients (40%). Alterations were seen in the development of the corpus callosum in six patients (30%), five in an isolated way and in one case there was partial absence of the associated septum pellucidum. Another patient was found to have an isolated partial agenesis of the septum and Goldenhar syndrome was detected in another case. The radiological follow up, which varied according to the initial clinical features, did not show any differences in the morphology or the size of the lipoma. CONCLUSIONS: 1) ICL are more frequently located in the interhemispheric fissure and in the quadrigeminal cistern; 2) In these locations they can be associated with other brain malformations, the most important being defects in the callosa and septa; 3) Most ICL were found incidentally during the course of a neuroimaging examination. Only in the case of three patients (15%) was there any presumed relation between the location of the ICL (pericallosal), the symptomatology (overall psychomotor retardation) and the associated malformation (hypoplasia of the corpus callosum); 4) The incidence of epilepsy was much lower than that claimed in earlier reports, and the predominant associated neurological symptomatology was found to be psychomotor retardation and headache (70%); 5) ICL is a developmental anomaly that does not require neurosurgical treatment and which does not usually change with the passage of time, although it is liable to increase because of adipose hypertrophy.

Lipomas intracraneales en pediatría: estudio retrospectivo de 20 pacientes / Intracranial lipomas in paediatrics: a retrospective study of 20 patients

Introducción. Los lipomas intracraneales (LIC) son malformaciones congénitas que se originan por una diferenciación anómala de la meninge primitiva. Objetivo. Conocer los síntomas que se relacionan más frecuentemente con los LIC en la edad pediátrica, así como valorar si tienen relación directa con su ubicación y con su asociación a otras malformaciones cerebrales. Pacientes y métodos. Se ha realizado un estudio clinicorradiológico retrospectivo de 20 pacientes pediátricos con LIC, diagnosticados entre 1985 y 2003, en tres hospitales de la Comunidad Valenciana. Resultados. El 70 por ciento de los casos son mujeres, y la edad media cuando se diagnóstico el LIC fue de 5,3 años (intervalo, de 2 meses a 13 años). La justificación clínica inicial más frecuente del estudio neurorradiológico fue retraso psicomotor, en ocho pacientes REV NEUROL 2003; 37 (6): 515-521 (40 por ciento), y cefalea persistente de predominio migrañoso, en seis (30 por ciento). Sólo un paciente se estudió por epilepsia. La localización dominante ha sido la cisura interhemisférica, en 10 pacientes (50 por ciento), seguida de la cisterna cuadrigémina, en cinco (25 por ciento), y el eje infundibulomamilar, en tres (15 por ciento). Un caso se localizó en el cerebelo, y otro en el ventrículo lateral con extensión a la cisura coroidea. Se observaron anomalías asociadas en ocho pacientes (40 por ciento). En seis pacientes (30 por ciento) se observó una alteración en el desarrollo del cuerpo calloso, en cinco de manera aislada y en uno con ausencia parcial asociada del septo pelúcido. En otro paciente se observó una agenesia parcial aislada del septo, y en otro caso se detectó un síndrome de Goldenhar. El seguimiento radiológico, variable según la clínica inicial, no mostró diferencias en la morfología ni en el tamaño del lipoma. Conclusiones. 1) Los LIC se localizan con mayor frecuencia en la cisura interhemisférica y en la cisterna cuadrigeminal; 2) En estas localizaciones pueden asociarse a otras malformaciones cerebrales, fundamentalmente defectos callosos y septales; 3) La mayor parte de los LIC representan un hallazgo incidental de neuroimagen; sólo en tres pacientes (15 por ciento) hubo una presunta relación entre la ubicación del LIC (pericallosa), la sintomatología (retraso psicomotor global) y la malformación asociada (hipoplasia del cuerpo calloso); 4) La incidencia de epilepsia ha sido mucho más baja que la descrita previamente, y se halló como sintomatología neurológica asociada predominante el retraso psicomotor y la cefalea (70 por ciento); 5) El LIC es una anomalía malformativa que no precisa tratamiento neuroquirúrgico y que no suele modificarse con el tiempo, aunque es susceptible de aumentar por hipertrofia adiposa (AU)

Introduction. Intracranial lipomas (ICL) are congenital malformations that are due to an anomalous differentiation of the primitive meninges. Aims. The purpose of this study is to determine the most frequent symptoms related to ICL in the paediatric age, as well as to evaluate whether they are directly related to their location and to their association with other brain malformations. Patients and methods. A retrospective clinico-radiological study was conducted involving 20 paediatric patients diagnosed as suffering from ICL between 1985 and 2003 at three hospitals in the Valencian Community. Results. 70% of the cases were females and the average age when ICL was diagnosed was 5.3 years (interval from 2 months to 13 years). The most common initial clinical justification for the neuroradiological study was psychomotor retardation in eight patients (40%) and persistent, predominantly migrainous, headaches in six of them (30%). Only one patient was examined because of epilepsy. The prevailing site was the interhemispheric fissure in 10 patients (50%), followed by the quadrigeminal cistern in five (25%) and the mamillary body-infundibulum axis in three of them (15%). One case was located in the cerebellum and another was found in the lateral ventricle, with involvement of the choroid fissure. Associated anomalies were observed in eight patients (40%). Alterations were seen in the development of the corpus callosum in six patients (30%), five in an isolated way and in one case there was partial absence of the associated septum pellucidum. Another patient was found to have an isolated partial agenesis of the septum and Goldenhar syndrome was detected in another case. The radiological follow-up, which varied according to the initial clinical features, did not show any differences in the morphology or the size of the lipoma. Conclusions. 1) ICL are more frequently located in the interhemispheric fissure and in the quadrigeminal cistern; 2) In these locations they can be associated with other brain malformations, the most important being defects in the callosa and septa; 3) Most ICL were found incidentally during the course of a neuroimaging examination. Only in the case of three patients (15%) was there any presumed relation between the location of the ICL (pericallosal), the symptomatology (overall psychomotor retardation) and the associated malformation (hypoplasia of the corpus callosum); 4) The incidence of epilepsy was much lower than that claimed in earlier reports, and the predominant associated neurological symptomatology was found to be psychomotor retardation and headache (70%); 5) ICL is a developmental anomaly that does not require neurosurgical treatment and which does not usually change with the passage of time, although it is liable to increase because of adipose hypertrophy (AU)

[Evolution of conservative treatment in traumatic spleen injuries. Report of 54 cases]. / Evolución en el tratamiento conservador de las lesiones esplénicas traumáticas: presentación de 54 casos.

The spleen is the organ most frequently affected in abdominal trauma. Conservative treatment of traumatic spleen injuries is already generally accepted, avoiding surgery whenever possible. We present a wide serie (54 cases) of traumatic spleen injuries along a period of ten years (1990-2000) during which 83% of these were solved with conservative therapy we analyse our treatment procedure and post-treatment follow-up of these patients.

[Ischemic stroke secondary to post varicella angiopathy in a 3 year old male]. / Accidente cerebrovascular isquémico secundario a angiopatía posvaricela en varón de 3 años.

INTRODUCTION: Ischemic cerebrovascular disease is an infrequent problem in the paediatric age, but one which we now understand better thanks to modern neuroimaging techniques. We know little about its aetiopathogenesis, which is very varied, and it has been reported as being associated with viral infections such as chicken pox. CASE REPORT: A male, aged 3 years, who presented sudden hemiparesis, facial paralysis and dysarthria, without any other accompanying neurological symptoms. The patient had suffered a bout of chicken pox 6 weeks earlier. Of the abnormal complementary explorations, the most notable were varicella positive serological tests and MRI and MR angiography that pointed to ischemic involvement of the cortex. The patient progressed very well and the clinical features had completely reverted at five weeks. CONCLUSION: Post varicella angiopathy is one of the acquired risk factors for an ischemic stroke, and has been claimed to account for up to a third of all strokes in infants. Neuroimaging techniques allow the topographic determination of the ischemic repercussions. Patients usually progress well and in most cases the clinical features completely revert within a short time. We conclude that chicken pox should be included in the vaccination schedule as soon as possible in order to prevent complications that, as in the case we have reported, can be very serious.

Accidente cerebrovascular isquémico secundario a angiopatía posvaricela en varón de 3 años / Ischemic stroke secondary to post-varicella angiopathy in a 3-year-old male

Introducción. La enfermedad cerebrovascular isquémica es un problema poco frecuente en la edad pediátrica, pero cada vez mejor estudiado con las modernas técnicas de neuroimagen. La etiopatogenia es poco conocida y muy variada; se ha descrito su asociación con infecciones virales, como la varicela. Caso clínico. Varón de 3 años, que presenta un cuadro brusco de hemiparesia, parálisis facial y disartria, sin otra sintomatología neurológica acompañante. Muestra antecedente de varicela 6 semanas antes. De entre las exploraciones complementarias anormales, destaca la serología positiva para varicela y la RM y la angiorresonancia magnética cerebrales, indicativas de la afectación isquémica cortical. La evolución fue muy satisfactoria y el cuadro revirtió por completo a las cinco semanas. Conclusión. Entre los factores de riesgo adquiridos de un ictus isquémico, se encuentra la angiopatía posvaricela, que se ha llegado a responsabilizar de hasta la tercera parte de los accidentes cerebrovasculares isquémicos de la infancia. Con las técnicas de neuroimagen se pueden perfilar topográficamente las repercusiones isquémicas. La evolución suele ser muy satisfactoria y el cuadro revertir de forma completa con prontitud en la mayoría de las ocasiones. Se concluye con la necesidad de incluirla varicela en el calendario vacunal lo antes posible, para poder evitar complicaciones que en muchas ocasiones, como la que se describe, son muy serias (AU)

Evolución en el tratamiento conservador de las lesiones esplénicas traumáticas: presentación de 54 casos / Evolution of conservative treatment in traumatic spleen injuries. Report of 54 case

El bazo es el órgano que con más frecuencia se afecta en los traumatismos abdominales. En la edad pediátrica el tratamiento conservador de las lesiones esplénicas traumáticas está ya generalmente aceptado, evitando la cirugía siempre que sea posible. Presentamos una amplia serie (54 casos) de lesiones esplénicas traumáticas, en un período de 10 años (1990-2000), en la que el 83% delas mismas se resolvieron con tratamiento conservador. Analizamos nuestra pauta de tratamiento y seguimiento en estos enfermos (AU)

Langerhans' cell histiocytosis of the temporal bone in pediatric patients: imaging and follow-up.

OBJECTIVE: The purpose of this study was to review the initial clinical and radiologic manifestations and the follow-up of pediatric patients with Langerhans' cell histiocytosis affecting the temporal bone. MATERIALS AND METHODS: We retrospectively studied 14 patients with Langerhans' cell histiocytosis affecting the temporal bone. All patients were examined initially and sequentially with CT. In six patients, MR imaging was also done. RESULTS: Temporal bone involvement was the initial form of presentation in 12 patients. In eight patients, temporal bone involvement presented as an isolated manifestation, and in four it was associated with multisystemic involvement. In the remaining two patients, temporal bone involvement appeared during the course of the Langerhans' cell histiocytosis. Bilateral involvement was seen in four patients. In two patients, the temporal bone was affected only at the petrous apex. CT showed destruction of bone in all 14 patients and an associated soft-tissue homogeneous mass after injection of i.v. contrast material in 12 patients. CT showed a heterogeneous appearance of the soft-tissue mass in two patients. The average period of follow-up was 5 years. In seven of the 14 patients, the disease had a satisfactory evolution in which the bony lesions of the temporal bone reossified and remodeled over the course of a year. CONCLUSION: In Langerhans' cell histiocytosis, involvement of the temporal bone is usually seen on radiographs as extensive lytic lesions associated with soft-tissue masses. The lesions that remit show early disappearance of the soft-tissue mass, followed by reossification and remodeling of the involved bone. Patients with limited initial involvement of the temporal bone have a better prognosis on long-term follow-up than do patients with the multisystemic form.

[Sturge-Weber syndrome: experience with 14 cases]. / Síndrome de Sturge-Weber: Experiencia en 14 casos.

OBJECTIVE: The objective of this study was to review the cases of Sturge-Weber syndrome (SWS) diagnosed and followed-up in our center over the last 25 year period in order to evaluate their clinical characteristics, evolution and therapeutical response. PATIENTS AND METHODS: A retrospective review of the records of patients diagnosed of SSW (facial nevus flammeus at least over the first branch of the trigeminal nerve and ipsilateral leptomeningeal angioma) was performed. RESULTS: Fifteen patients were found in our records, with one of them being excluded from the study due to the lack of follow-up. From the remaining 14, 11 had been diagnosed before the age of 18 months. Nevus flammeus was located on the right side in 8 cases, bilaterally in 3 and on the left side in the other 3 patients. Four cases had glaucoma, 3 of which had good evolution after trabeculotomy. Thirteen of the 14 patients had seizures, usually contralateral to the nevus flammeus. The main drugs used were phenytoin, phenobarbital, valproic acid and carbamazepine. Ten of the 13 patients treated had a good therapeutical response. The EEG was abnormal in 12 patients, two of them occurring during the follow-up period. The main abnormality found was an interhemispherical asymmetry. Nine patients developed hemiparesis. In reference to the neuroimaging. MR was better than CT in evaluating parenchymatous atrophy, which was present in all patients, and the abnormalities of the white and grey matters (9 and 8 patients, respectively). CONCLUSIONS: Early evaluation of newborns with nevus flammeus affecting the first branch of the trigeminal nerve must be done, including an MR with contrast and an ophthalmological exam.

[A new method for the measurement of the anatomical development of the muscle complex of the anus in children with anorectal malformations]. / Nuevo método de cuantificación del desarrollo anatómico del complejo muscular del ano en los niños con malformación anorrectal.

We present a new method for the measurement of the anorectal muscle complex. We studied 40 children with anorectal malformation (14 low and 16 high). Taking the perineal TAC with a rectal probe and quotient called "C": [formula: see text] A "C" value less than 0.31 indicates little development of the anus muscle complex. In 10/26 patients with high malformation, "C" was less than 0.31. All of these patients had fecal incontinence.

Complications of hepatic hydatid cysts: ultrasound, computed tomography, and magnetic resonance diagnosis.

A total of 179 hepatic hydatid cysts (HHCs) were studied by ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The diagnosis of HHC complications was established by US and CT, which permitted a distinction between intact cysts and those presenting with contained rupture, as demonstrated by a collapsed endocyst or a globally echogenic appearance. The diagnosis of HHC perforation into the main biliary tree was made by detection of a discontinuity in the cyst wall and/or the presence of hydatid material within the biliary system. Similarly, direct HHC rupture into different thoracoabdominal spaces was diagnosed by demonstrating cyst wall discontinuity and the presence of hydatid material within these spaces. Ruptured and infected cysts were difficult to distinguish from ruptured cysts with sterile content. The role of MRI is yet to be defined in the assessment of HHC complications.

[Isolated retroperitoneal hydatid cyst. CT study. Apropos of a case]. / Kyste hydatique rétropéritonéal isolé. Etude TDM. A propos d'un cas.

A 30 year old patient with isolated retroperitoneal hydatid cyst was the first case of this type to be studied by CT scanning. Isolated retroperitoneal hydatid cyst is defined as any zone of hydatidosis occurring in the fatty tissue of the spaces lying behind posterior parietal peritoneum, without any parasitic foci in other organs. Differential diagnosis from other primary retroperitoneal cysts has been improved by the availability of modern imaging procedures: ultrasonography and CT scan.