Unusual intramuscular locations as a first presentation of hydatid cyst disease in children: a report of two cases
Tóm tắt
Hydatid disease is an endemic disease in many countries of the world including the Middle East. It mainly affects the liver and lungs. Intramuscular hydatid disease is rarely reported in children. Such uncommon localization of hydatid cyst may pose difficulties in the clinical and radiological diagnosis; hence affecting patient’s management and outcome even in endemic areas.
We herein describe intramuscular hydatid cysts in 2 different children. The first case is a 5-year-old boy who presented with a painless palpable lump over the right lumbar paraspinal region. His history was remarkable for sheep contact. His laboratory results revealed a mild increase in white blood cell (WBC) count and C-reactive protein. The lesion showed typical features of a hydatid cyst on ultrasound. Further imaging including ultrasound of the abdomen and CT of the chest, abdomen, and pelvis showed infestation of the liver and lung as well. The lesions were resected surgically without complications. The patient received Albendazole preoperatively and after surgery for 3 months. No evidence of recurrence was seen during follow-up.
The second case is a 6-year-old girl who presented with an incidental palpable lump in her left thigh during her hospital admission for recurrent meningitis. Ultrasound and MRI imaging were performed demonstrating a unilocular cystic lesion in the left proximal rectus femoris muscle. A provisional diagnosis of hematoma vs. myxoma was given. Biopsy was performed and yielded blood products only. The lesion was resected surgically with a postoperative diagnosis of hydatid cyst. Blood tests performed afterward showed a positive titer for Echinococcus. The patient received Albendazole for 3 months. No evidence of recurrence was seen during follow-up.
Despite its rarity; skeletal muscle hydatid cyst should always be considered in the differential diagnosis of cystic muscle lesions in children in endemic areas even if imaging studies did not show any of the typical signs. This will improve patient outcome by preventing unnecessary cystic puncture which might lead to serious complications, such as anaphylaxis and local dissemination.
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Comert RB, Aydingoz U, Ucaner A, Arikan M. Water-lily sign on MR imaging of primary intramuscular hydatidosis of sartorius muscle. Skelet Radiol. 2003;32(7):420–3. https://doi.org/10.1007/s00256-003-0661-x.
Kurz K, Schwabegger A, Schreieck S, Zelger B, Weiss G, Bellmann-Weiler R. Cystic echinococcosis in the thigh: a case report. Infection. 2019;47(2):323–9. https://doi.org/10.1007/s15010-018-1255-9.
Sreeramulu PN. Krishnaprasad, Girish gowda SL. Gluteal region musculoskeletal hydatid cyst: case report and review of literature. Indian J Surg. 2010;72(S1):302–5. https://doi.org/10.1007/s12262-010-0096-2.
Din DPMU, Anjum WA, Ahmad ML, Rehman KA, Ahmad GB, Gulshan WN. Primary para-vertebral hydatid cyst in the sub-occipital area of the neck: an unusual case of echinococcosis. Egypt J Neurosurg. 2018;33(1):16. https://doi.org/10.1186/s41984-018-0015-6.
García-Díez AI, Ros Mendoza LH, Villacampa VM, Cózar M, Fuertes MI. MRI evaluation of soft tissue hydatid disease. Eur Radiol. 2000;10(3):462–6. https://doi.org/10.1007/s003300050077.
Alam W, Shah F, Ali MA. Hydatid cystic disease of lumbar paraspinal muscles. Biomed J Sci Tech Res. 2017;1(6). https://doi.org/10.26717/BJSTR.2017.01.000495.
Tekin R, Avci A, Tekin RC, Gem M, Cevik R. Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation. Rev Soc Bras Med Trop. 2015;48(5):594–8. https://doi.org/10.1590/0037-8682-0197-2015.
Atalar MH, Cankorkmaz L, Koyluoglu G, Salk I. Imaging characteristics of three primary muscular hydatid cyst cases with various patterns. Kafkas J Med Sci. 2012;2:74–6. https://doi.org/10.5505/kjms.2012.76486.
Alaskar FA, Aldameg M. Hydatid disease with water lily sign manifesting as a soft-tissue mass in the soleus muscle of an adult woman : case report. Egypt J Hosp Med. 2018;71(3):2788–91. https://doi.org/10.12816/0045845.
Alatassi R, Koaban S, Alshayie M, Almogbil I. Solitary hydatid cyst in the forearm: a case report. Int J Surg Case Rep. 2018;51:419–24. https://doi.org/10.1016/j.ijscr.2018.09.038.
Merkle EM, Schulte M, Vogel J, Tomczak R, Rieber A, Kern P, et al. Musculoskeletal involvement in cystic echinococcosis: report of eight cases and review of the literature. AJR Am J Roentgenol. 1997;168(6):1531–4. https://doi.org/10.2214/ajr.168.6.9168719.
García-Alvarez F, Torcal J, Salinas JC, Navarro A, García-Alvarez I, Navarro-Zorraquino M, et al. Musculoskeletal hydatid disease: a report of 13 cases. Acta Orthop Scand. 2002;73(2):227–31. https://doi.org/10.1080/000164702753671858.
Geramizadeh B. Unusual locations of the hydatid cyst: a review from Iran. Iran J Med Sci. 2013;38(1):2–14.
El Harroudi T, Souadka A, Tijami F, El Otmany A, Jalil A. Primary paraspinal hydatid cyst: a case report. Internet J Orthop Surg. 2012;13:13–6.
Ghoroobi J, Mohajerzadeh L, Mirshemirani A, Mahdavi A. Primary hydatid cyst of thigh: a case report in child. J Krishna Inst Med Sci Univ. 2017;6:111–3.
Durakbasa M, Kose O, Islam N, Kilicoglu G. A primary hydatid cyst of the gracilis: a case report. J Orthop Surg. 2007;15(1):118–20. https://doi.org/10.1177/230949900701500127.
Sener R, Calli C, Kitis O, Yalman O. Multiple, primary spinal–paraspinal hydatid cysts. Eur Radiol. 2001;11(11):2314–6. https://doi.org/10.1007/s003300000771.
Kerimoglu U, Kapicioglu S, Emlik D, Arazi M, Ural O. Case 161: hydatid disease with water lily sign manifesting as a soft-tissue mass in the calf of a child. Radiology. 2010;256(3):1007–10. https://doi.org/10.1148/radiol.10081066.
Adıyeke L, Cakır T, Duymus TM, Aydogmus S. Unexpected diagnosis in gluteal region -a primary intramuscular hydatid cyst: a case report. J Orthop Case Rep. 2018;8(2):104–6. https://doi.org/10.13107/jocr.2250-0685.1072.
Duygulu F, Karaoǧlu S, Erdoǧan N, Yildiz O. Primary hydatid cyst of the thigh: a case report of an unusual localization. Turk J Pediatr. 2006;48(3):256–9.
Erol B, Tetik C, Altun E, Soysal A, Bakir M. Hydatid cyst presenting as a soft-tissue calf mass in a child. Eur J Pediatr Surg. 2007;17(1):55–8. https://doi.org/10.1055/s-2007-964949.
Dudkiewicz I, Salai M, Apter S. Hydatid cyst presenting as a soft-tissue thigh mass in a child. Arch Orthop Trauma Surg. 1999;119(7-8):474–5. https://doi.org/10.1007/s004020050025.
Cankorkmaz L, Ozturk H, Koyluoglu G, Atalar MH, Arslan MS. Intermuscular hydatid cyst in a 4-year-old child: a case report. J Pediatr Surg. 2007;42(11):1946–8. https://doi.org/10.1016/j.jpedsurg.2007.07.051.
Maha L, Daib A, Hella Y, Boughdir M, Ben Abdallah R, Trabelsi F, et al. A rare etiology of muscular mass in infant: a case report. J Heal Med Sci. 2019;2:275–8.