Case 269: Sacroiliac Joint Hydatid Disease.

HistoryA 20-year old woman living in Turkey presented with a 3-month history of lower back pain. She had no medical history of note and was taking no medications. Complete blood count, C-reactive protein level, sedimentation rate, and creatinine, alanine aminotransferase, and aspartate aminotransferase levels were within normal limits. Anteroposterior pelvic radiography and unenhanced pelvic CT were performed to rule out sacroiliitis. The imaging findings were abnormal, and the patient underwent contrast-enhanced sacroiliac MRI. A few days later, she underwent contrast-enhanced (100 mL iohexol, Omnipaque; GE Healthcare, Cork, Ireland) abdominal CT because of right upper quadrant pain.

Cauda equina syndrome caused by primary lumbosacral and pelvic hydatid cyst: a case report.

INTRODUCTION: Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare. CASE REPORT: We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief. DISCUSSION: Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.

Primary hydatid disease of sacrum affecting the sacroiliac joint: a case report.

STUDY DESIGN: A case report of hydatid disease of the spine. OBJECTIVE: To describe an unusual case of hydatid disease of the sacrum affecting the sacroiliac joint and to discuss imaging, differential diagnosis, and treatment. SUMMARY OF BACKGROUND DATA: Hydatidosis or echinococcosis affecting the spine is rare and has a characteristic geographic distribution. Signs of sacroiliac joint involvement and accompanying neurologic deficits cause difficulties in differential diagnosis of this rare condition. METHODS: A case of 38-year-old female patient with low back pain and sciatica was presented. RESULTS: Plain radiographs, computed tomography, and magnetic resonance imaging scans revealed destructive expansive lesion located on the right sacrum and extended through the right sacroiliac joint. Surgical enucleation of the cysts was performed together with mebendazole treatment and histopathologic examination confirmed hydatidosis. CONCLUSION: This unusual disease should be kept in mind in the differential diagnosis of sacroiliac pain and sciatica, especially in endemic areas.