Musculoskeletal hydatid disease: report of a rare case with primary and exclusive localization in right hemi-pelvis and femur.

Hydatid Disease (HD), also called Echinococcosis or Hydatidosis, is a parasitic infection caused by the larval stage of the tapeworm Echinococcus: E. granulosus or E. multilocularis. HD occur most frequently in liver or lungs, rarely in brain, skeletal muscles, bones, kidneys, spleen. Bone infestation of Echinococcosis hydatid cysts occurs respectively by haematogenous seeding and progressive invasion into bone by lesions in the adjacent soft tissues. Patients with musculoskeletal HD clinically show the disease in adulthood because the lesions develop very slowly. In some cases, HD is an uncommon cause of soft tissue mass, pain and neurovascular symptoms due to compression or to secondary infection. Diagnostic imaging plays an important role in the diagnosis of HD and in the differential diagnosis with soft tissue tumors. We present a rare case of male patient of 42 year-old with diagnosis of HD with primary and exclusive localization in right hemi-pelvis and femur.

Musculoskeletal hydatid disease.

Hydatid disease is an infectious disease caused by the larval stage of the parasitic tapeworm Echinococcosis granulosus. Its distribution is worldwide. Although hydatid disease can develop in almost any part of the body, it is most commonly found in the liver and lung. Musculoskeletal involvement is rare. The radiological appearance of the hydatid disease of musculoskeletal system mimics tumors and other inflammatory conditions. Therefore preoperative diagnosis of musculoskeletal hydatid disease is sometimes difficult clinically and radiologically. On radiography, different radiographic changes may occur. In cases of osteolytic and inflammatory changes, it may mimic any variant of nonspecific or specific osteomyelitis. Bone erosion and destruction may lead to almost complete osteolysis, bone may distort, and on occasion, its radiologic appearances may be confused with those of a malignant bone tumor. Computed tomography (CT) is more accurate in delineating the area of destruction. The primary role of CT and magnetic resonance imaging is in the recognition of extraosseous spread of the hydatid disease within the soft tissues. This article reviews the pathological basis and the clinical and imaging features of musculoskeletal hydatid disease.

[Descriptive epidemiology of extrapulmonary hydatid cysts: a report of 265 Tunisian cases]. / Profil epidémiologique descriptif des kystes hydatiques extra pulmonaires: a propos d'une série tunisienne de 265 cas.

BACKGROUND: Hydatidosis is a parasitic endemic disease in Tunisia. The liver and lung are the most common sites of involvement; however, it can develop anywhere in the body. AIM: The aim of the present study was to analyse the epidemiological features of extrapulmonary hydatid cysts and compare our results with those reported in literature. METHODS: A retrospective study of 265 extrapulmonary hydatid cysts collected over the 18-year period from 1990 to 2007 was undertaken. RESULTS: There were 101 male and 164 female patients (sex ratio M/F = 0.61) ranging in age from 2 to 84 years (mean age = 38.7). In our series, hydatid cysts involved mainly the kidney (24.1%), the central nervous system (22.6%), the liver (19.6%) and the spleen (11.3%). The other less frequent sites included the peritoneum (n = 9), heart (n = 9), bone (n = 6), adrenal gland (n = 4), epiploon (n = 4), orbit (n = 4), ovary (n = 3), prostate (n = 2), bladder (n = 2), breast (n = 2), Douglas' cul-de-sac (n = 2), diaphragm (n = 1), testis (n = 1), broad ligament (n = 1), mediastinum (n = 1), nasal cavity (n = 1), soft tissue (n = 1), abdominal wall (n = 1), parotid gland (n = 1), psoas muscle (n = 1), synovia (n = 1), thymus (n = 1) et le pancreas (n = 1). CONCLUSION: In contrast to literature, our results show that hydatid cysts of the kidney and of the central nervous system are more frequent than hepatic location which occupies the 3rd rank.

A primary hydatid cyst of the gracilis: a case report.

Primary hydatid disease of the skeletal muscle without systemic involvement is rare. A 40-year-old woman presented with a painful mass in her medial left upper thigh. She was misdiagnosed as having a deep intramuscular abscess and a fine needle aspiration was performed, but the fluid came out crystal clear. Further inquiry revealed that her 16-year-old daughter had been operated on twice for liver and lung hydatid disease. Thus, a provisional diagnosis of hydatid disease was made. An echinococcal haemagglutination test was positive. Ultrasonography and magnetic resonance imaging findings were consistent with a type-2 hydatid cyst showing a 'water-lily' sign. The cystic mass within the left gracilis was resected en bloc. Adjunctive albendazole chemotherapy (400 mg/day) was prescribed for 3 months. At the 22-month follow-up, the patient remained free of symptoms.

Unusual site of recurrent musculoskeletal hydatid cyst: case report and brief review of the literature.

A case of a large multiplex recurrent hydatid cyst involving the left gluteal muscle and the left iliopsoas, accompanied with degeneration of the musculature of the left upper leg is presented along with a review of the relevant literature. Very few such cases have been reported worldwide. The presented case is also distinguished by the involvement of muscles of distant anatomic areas.

[Musculoskeletal hydatidosis: an unusual location]. / Hidatidosis musculoesquelética: una localización atípica.

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness.

Musculoskeletal and adipose tissue hydatidosis based on the iatrogenic spreading of cystic fluid during surgery: report of a case.

Hydatidosis or echinococcosis is a parasitic disease caused by Echinococcus granulosus or E. multilocularis, which forms cysts in the liver and lung after penetrating the duodenal mucosa and entering the portal circulation. The liver and lung act as a filter but some embryos enter the general circulation and disseminate throughout the body. Musculoskeletal involvement is a rare manifestation of hydatidosis, which is usually reported to affect a single muscle. We report here a rare case of a 68-year-old man with widespread hydatidosis of the retroperitoneum and the subcutaneous adipose tissue, and with multiple muscle involvement in the absence of liver, lung, and spleen involvement. The patient underwent surgical excision of a subcutaneous hydatid cyst 7 years earlier. It is likely that the large dissemination of parasites resulted from accidental rupture of the primary focus during surgery with consequent release and spreading of scolices via lymphatics.

Subcutaneous and musculoskeletal sparganosis: imaging characteristics and pathologic correlation.

OBJECTIVE: To document the imaging characteristics of subcutaneous and musculoskeletal sparganosis. DESIGN AND PATIENTS: Ten patients with musculoskeletal sparganosis were examined, with a variety of imaging modalities including MRI (n=6), ultrasonography (n=8), plain radiography (n=7) and CT (n=1). Pathologic correlation was carried out in all cases. RESULTS: Nine lesions involved soft tissues, of which seven were in the thigh, two in the trunk and one involved a vertebral body. The majority of the lesions in soft tissue were confined to the subcutaneous layer but two extended deep into underlying muscles. Sonography revealed low-echoic serpiginous tubular tracts (8/8), and an intraluminal echogenic structure (4/8). MRI revealed multiple serpiginous tubular tracts and peripheral rim enhancement. Two patients showed perilesional soft tissue edema. Pathologically, the lesion consisted of a larva surrounded by three layers of inflammation: an inner epithelioid granulomatous cell layer, middle chronic inflammatory cell layers, and an outer fibrous layer. CONCLUSION: The study suggests that if serpiginous tubular tracts are seen at imaging studies, musculoskeletal sparganosis should be included in the differential diagnosis.

Musculoskeletal syndromes in parasitic diseases.

Parasitic infestation can induce a variety of rheumatic syndromes as a result of infiltration of musculoskeletal structures by parasites or an immune mediated mechanism. Parasite-induced symptoms should be considered when arthritis, enthesitis, myositis, or vasculitis develop in patients residing in endemic areas and in certain subsets of the population of developed countries, for example, migrants, travelers, and immunocompromised individuals. Diagnosis is based on the demonstration of infection with a pathogenic parasite, lack of response to anti-inflammatory agents, and improvement following antiparasitic therapy. Treatment consists of erradication of the parasite.