Abstract
We report a rare case of 50-year-old Moroccan woman with local recurrence of a subcutaneous hydatid cyst in proximity to the medial surface of the tibia and another cyst at the tibialis posterior muscle in the absence of liver, lung und spleen involvement. The first surgery was done in another hospital three years ago; no adjuvant treatment was performed after surgery. Recurrence was diagnosed according to the MRI appearance, serological and pathological findings. The patient underwent complete excision of the subcutaneous cyst with two centimeters of the medial gastrocnemius muscle; the tibialis posterior muscle cyst was intraoperatively drained and irrigated with scolicidal agent as it was next to the posterior tibial pedicle. A periopertive anthelmintic chemotherapy was administered. Two years after the patient showed no recurrence. This case report and literature review describe an approach to the diagnosis and management of this pathological entity.
Highlights
Echinococcosis has its highest prevalence in countries, where the common intermediate hosts, sheep and cattle, are raised [1, 2]
We present a case of recurrent hydatid cysts involving the medial surface of the tibia and the tibialis posterior muscle
A 50 year old Moroccan female patient of rural origin presented in Avicenna hospital Rabat-Morocco with history of pain and swelling of the medial aspect of the right leg for two years
Summary
Echinococcosis has its highest prevalence in countries, where the common intermediate hosts, sheep and cattle, are raised (such as Middle East, Mediterranean region, Central Europe, Australia and South America) [1, 2]. We present a case of recurrent hydatid cysts involving the medial surface of the tibia and the tibialis posterior muscle. The patient had been operated, in another hospital, three years earlier for echinococcosis of the subcutaneous tissue of the right leg with no adjuvant treatment. MRI (Magnetic Resonance Imaging) revealed the presence of a subcutaneous collection in proximity to the medial surface of the tibia at the junction of his upper and middle third adherent to the periosteum with a thick and scalloped wall, enhanced after gadolinium injection and fluid filled measuring 52×28×72 mm and a second deep collection at the tibialis posterior muscle measuring 21×9×38 mm sitting in front of the posterior tibial and peroneal arteries (Figure 3). At two years follow up, no sign of local or distant recurrence was noted and the patient sill under medical surveillance each six months
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