Mediastinal dumbbell hydatid cyst compressing the thoracic spinal cord: A case report and literature review

Abstract

Introduction: Hydatid disease, or echinococcosis, is a parasitic infection of humans caused by tapeworms of the genus Echinococcus. The liver and lungs are the most common organs to be involved. Mediastinal and bone involvement were reported to be rare, 0.1% and 0.5–4%, respectively. Spine involvement has been reported in 50% of patients with bone involvement. Case Report: We presented a rare case of an 18-year-old male patient with a recurrent mediastinal hydatid cyst which widened the neural foramina, extended into the spinal canal, and compressed the spinal cord. He presented with back pain, spastic paraparesis, and bowel/bladder incontinence. Computed tomography (CT) and magnetic resonance imaging (MRI) showed polycystic mediastinal mass with erosion of the upper thoracic vertebra and the rib; widening of the neural foramina; extension into the spinal canal and compression of the spinal cord. The patient was operated on. Through a posterior approach, the polycystic mass was removed totally. The mass in the mediastinal (paravertebral) area was removed totally through the widened neural foramen. The cavity was washed with 3% hydrogen peroxide. The histopathology confirmed the diagnosis of a hydatid cyst. Postoperatively the patient was treated with oral albendazole for six months. On the sixth month follow-up, the neurologic status had only mild improvement and the follow-up scan did not show any recurrence of the infection. Conclusion: Hydatid cysts can rarely involve the mediastinal (paravertebral) area and can extend to the spinal epidural space causing neurologic compromise.