Primary Thoracic Wall Hydatid Cyst Extended to the Abdominal wall: A Case Report.

Hydatid disease (HD) is an infectious disease caused by echinococcosis. Hydatid cyst (HC) most commonly invades the liver (60-70%) and the lungs (20-25%). However, other parts of the body and even unusual locations can be infected, mimicking a benign lesion that could be easily missed. Primary HC of the chest wall is extremely rare, even in countries where echinococcosis is endemic.We herein present a case of a 40-year-old man with a right-sided growing thoracic wall mass. The patient did not present the relevant history (living in rural areas or being in contact with farm animals) and the serological examination with the indirect hemagglutination test was negative. During surgery, a cystic mass between the eleventh and twelfth ribs was observed. The thoracic wall mass extended to the posterior abdominal wall and was entirely extrapulmonary and extraperitoneal. All cystic structures of the thoracic wall and intrathoracic region were removed, and the primary defect was reconstructed. In endemic areas such as Iran, HD should be considered in the differential diagnosis of mass lesions located in the chest wall or other parts of the body, even without the relevant history or serologic evidence

DiFFUerent Locations of Hydatid Cysts

Cystic echinococcosis (CE) is a zoonosis caused by Echinococcus granulosus. It is difficult to diagnose CE by clinical symptoms alone, therefore, radiological and serological examinations should be conducted as well. The aims of this retrospective study were to evaluate the biochemical, hemogram, serological and radiological findings of patients prediagnosed as CE, and to survey epidemiological data to detect the status of the disease in our region. A total of 253 patients (148 female, 105 male) who were admitted to Hitit University Training and Research Hospital in Corum province (located in the central Black Sea Region of Turkey), between October 2009 to July 2013, were included in the study. Serum samples collected from the patients were analyzed by indirect hemagglutination (IHA) test, in the Microbiology Reference Laboratories of the Turkish Public Health Institute, and 1/160 and higher titers were considered positive. Twenty-three (15.5%) of female patients and nine (8.6%) of male patients, with a total of 32 (12.7%) were found to be seropositive. The difference between the gender was not statistically significant (X2= 2.72). The age range of the 32 seropositive patients was between 16-90 years (mean: 51), and of them 24 (75%) being over 40 years old was found as statistically significant (X2= 22.45). All of the seropositive patients presented radiological findings diagnosed with ultrasonography and computed tomography. Additionally, it was noticed that two patients (one male, one female) who were seronegative by IHA test, have passed a CE operation and the diagnosis was confirmed with pathological findings. Of the patients 43.8% were admitted to general surgery, followed by infectious diseases (21.9%), gastroenterology (21.9%) and other (12.5%) clinics. Radiological diagnosis showed that 31 (96.9%) of seropositive patients had CE in the liver, of them two (6.3%) also had lung involvement, while one patient (3.1%) had intraperitoneal involvement alone, without liver infection. Although 50% (16/32) of patients resided in Çorum urban area, most of them were dealing with agriculture and animal breeding. Among the biochemical parameters, GGT were detected with highest level (28%), followed by ALT (16%), AST (16%) and ALP (13%), while the other parameters were normal. Elevated RDW level was the most frequently observed result (29%) among hemogram parameters, while decreased levels of hematocrit, hemoglobin and MCV were detected in 23%, 19% and 19% of the patients, respectively. Eosinophilia was detected in 19% of the patients. In conclusion, for the diagnosis of CE, which is still an important public health problem in our region, a comprehensive evaluation of clinical, radiological, serological and biochemical findings is needed, to avoid a confusion of other diseases with similar clinical symptoms.

Primary hydatid cyst in the deltoid muscle: an unusual localization

Objectives: To document unusual locations of hydatid disease by Radiological Imaging performed in a Tertiary care center. Study Design: Descriptive Case series. Setting: Department of Radiology and Imaging, HBS General Hospital, Islamabad. Period: Jan 2016 to Dec 2018. Material & Methods: 64 cases of hydatid disease were included in our study seen between 2016 and 2018. 11 cases were retrospectively analyzed because of their unusual locations. MDCT was performed in all of our cases. Ultrasound, MRI, Color Doppler, IVU, and plain films also were performed in selected cases. Histopathological diagnosis of hydatid disease was confirmed in all cases operated surgically. Results: Rare locations of hydatid disease in this series included kidney, abdominal wall, chest wall, ovary, lumbosacral spine, iliopsoas muscles, mesentery, lung hilum, diaphragm, spleen and bronchus (in form of Broncho-pleural fistula). The Table-I, is most unusual presentations were passage of cysts in urine in a case of renal hydatid cyst, passage of cysts with haemoptysis in a case of bronchopleural fistula caused by ruptured hydatid cyst, infertility in an ovarian hydatid cyst, abdominal and chest wall swellings due to hydatid cysts. Even though there was no mortality in these patients, there was disabling morbidity. Conclusion: Hydatid disease can present with unusual symptoms and signs depending on the organ of involvement. Hydatid disease can affect any organ in the body and a high suspicion of this disease is justified in any unusual cystic lesion of any organ, Moreover, detailed imaging techniques should precede and follow the surgical intervention. Multi-imaging modalities are also more helpful in rare diffuse hydatidosis.

Hydatid disease mostly caused by Echinococcus granulosus (dog tape worm) is a common parasitic disease in pastoral areas. It produces cysts in the human body. Human is an accidental intermediate host. Most common sites are liver and lungs. Intraperitoneal hydatid cyst occurs sometimes and it is usually secondary to rupture of primary hepatic hydatid cyst. Primary intraperitoneal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. Small bowel volvulus is rare but documented complication of tumours of the mesentery, including cysts. In this article, the authors present a case of primary mesenteric hydatid cyst with acute intestinal obstruction secondary to volvulus.

Hydatid disease mostly caused by Echinococcus granulosus is a common parasitic infestation of the liver. Most common sites are liver (70%) and lungs (25%). Intraperitoneal hydatid cyst is found in...

Serologic studies on sera from native Mississippi swine with hydatid cysts have shown that Echinococcus antibody can be detected by the indirect hemagglutination test, the complement fixation test, and the precipitin test. The indirect hemagglutination test was more sensitive (76.5% of 64 sera) than the precipitin test (47.2% of 64 sera) or the complement fixation test (3.1% of 64 sera). In testing sera from pigs having cysts of unknown etiology, positive serologic reactions were obtained in 85.7% in the indirect hemagglutination test, in 66.6% in the precipitin test, and in 0.0% in the complement fixation test. Sera from pigs with no evident infection gave positive reactions in the indirect hemagglutination test (22.2%) and were negative in the complement fixation test. The significance of positive serologic tests in sera from pigs with cysts of unknown etiology and from pigs with no evident infection is discussed. Although Echinococcus infection in pigs is of considerable economic importance, since the organs involved must be destroyed, reports concerned with the detection of Echinococcus antibody in infected pigs are uncommon in the literature. Bonelli (1934) was unable to detect precipitins in the serum from swine found to have hydatid disease. Urbain (1936), however, reported that five of seven pigs harboring the infection were positive by the complement fixation test. The pig is the chief host for the larval stage of Echinococcus granulosus in Mississippi (Hutchison, 1960; Hutchison and Bryan, 1960). Since 1957, it has been possible to obtain sera from a number of pigs infected with this parasite. This paper reports the results obtained when these sera were tested for hydatid antibody by means of the indirect hemagglutination (IH) test, the complement fixation (CF) test, and the precipitin (P) test. MATERIALS AND METHODS Pig sera were divided into three groups which included: (1) 64 sera from native Mississippi swine with proven hydatid cysts containing scolices; (2) 35 sera from Mississippi swine having cysts of unknown etiology; and (3) 18 sera from native Mississippi swine which showed no evidence of infection or cystic structures of any kind. The pigs were under 2 years of age and most were under 1 year of age. All were slaughtered at the Jackson Packing Company, Jackson, Mississippi. Received for publication 21 June 1967. * This study was supported in part by Research Grant AI-01237 from NIAID, U. S. Public Health Service. The antigen employed in all tests was pig hydatid cyst fluid from fertile cysts. Before use, the cyst fluid was tested for antigenicity by titration with a serum of high titer. The 50% CF Test of the Serology Research Laboratory, Communicable Disease Center, Atlanta, Georgia, was employed. This procedure is based on the work of Schubert, et al. (1955). The P Test was a simple interfacial ring test using small tubes 50 mm long by 6 mm diameter. Equal volumes of hydatid cyst fluid antigen were layered over dilutions of sera being tested. The tubes were sealed with nail polish to prevent evaporation and were examined periodically up to 72 hr for evidence of precipitation at the interface. Precipitation at the interface of any serum dilution was considered a positive test. The IH Test performed was a modification of that described by Boyden (1951). The antigen was fixed onto tannic acid-treated sheep red blood cells, which had been preserved in Alsever's solution for at least 4 days prior to use. On the day of the test, a portion of the sheep red blood cells was washed three times in phosphate buffered saline (pH 7.2). After the last wash the cells were used in the test if the supernatant was clear. The cells were resuspended in pH 7.2 buffered saline to make a 2.5% suspension. An equal volume of 1:20,000 tannic acid in buffered saline was added and the mixture incubated at 37 C for 10 min. The cells were then washed free of excess tannic acid with buffered saline and resuspended as a 2.5% suspension. One volume of a 1:4 dilution of hydatid cyst fluid antigen in buffer was added to an equal volume of tanned cells and allowed to stand at room temperature for 15 min. The antigen treated tanned cells were washed with 1:250 normal rabbit serum in buffer and resuspended as a 2.5% suspension. Four-fold dilutions of sera were prepared with 1:100 normal rabbit serum starting at a dilution of 1:10. One drop of antigen-treated cells was added to 0.5 ml of diluted serum. The erythrocyte pattern on the

Introduction:Primary hydatid cyst is rarely seen in musculoskeletal system. This paper presents a case of an intramuscular hydatid cyst in gluteal region.Case of Report:We present the case of a 36-year-old woman affected by pain and a mass in her right gluteal region. Serological tests and radiographies were inconclusive. Ultrasonography showed a 52 mm × 47 mm diameter hypoechoic intramuscular cyst with septations. Computed tomography showed a cystic lesion located between muscle groups. The mass was excised under spinal anesthesia. It was a well-demarcated cystic lesion with 5 cm diameter. Albendazole chemotherapy was prescribed postoperatively.Conclusion:Hydatid cysts must be considered in differential diagnosis in patients with cystic masses in musculoskeletal system, especially in patients living in endemic areas.

Primary hydatid disease of chest wall mimicking chest wall mass-case report

Introduction: Primary pleural hydatidosis is a rare manifestation of cystic echinococcosis, a zoonotic parasitic disease caused by Echinococcus granulosus. While the liver and lungs are the most common sites of infection, pleural involvement is uncommon and often overlooked. This review aims to provide a comprehensive overview of primary pleural hydatid cysts by analyzing their epidemiological patterns, clinical presentations, diagnostic approaches, treatment strategies, and patient outcomes. Materials: A systematic literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, without time restrictions, employing MeSH terms related to pleural and extrapulmonary hydatidosis. Forty-four articles published between 1964 and 2024 were included, yielding data on 36 patients. Results: A total of 36 cases of primary pleural hydatid cysts were identified from 34 published reports. Patients’ ages ranged from 10 to 79 years (median, 24 years), with a male predominance (58.3%). The most frequently reported symptoms were chest pain (58%), dyspnea (50%), cough (47%), and fever (31%), while thoracic masses and asymptomatic presentations were less common (11% each). Right-sided pleural involvement was observed in 64% of cases. Hydatid serology was positive in 13 patients, negative in 5, and unreported in 18. Pleural fluid analysis was performed in 4 cases, all of which were positive for Echinococcus granulosus or hydatid-specific IgG. Imaging primarily included chest X-ray (83%), computed tomography (92%), and ultrasound (14%). Treatment strategies included surgery alone (47%), surgery with postoperative albendazole (39%), combined pre- and postoperative albendazole with surgery (11%), and albendazole monotherapy (3%). The most favorable outcomes were observed with combined pre- and post-operative albendazole and surgery (100%), followed by surgery with post-operative albendazole (71%). Discussion: Primary pleural hydatid cysts are exceptionally rare, with only a few cases reported worldwide. Their pathogenesis remains unclear, although hematogenous dissemination may explain isolated pleural involvement without hepatic or pulmonary disease. Clinical manifestations are often nonspecific, and diagnosis relies primarily on imaging, particularly computed tomography, which aids both detection and surgical planning. Serological tests may support diagnosis but have limited specificity. Surgery remains the treatment of choice, while adjuvant albendazole therapy helps reduce the risk of recurrence. Conclusion: Given the rarity and non-specific presentation of primary pleural hydatid disease, a high index of clinical suspicion is necessary. Early diagnosis and combined surgical and medical treatment generally result in good prognoses. Further studies are warranted to refine diagnostic and therapeutic protocols.

ERCP treatment of obstructive jaundice caused by hydatid cyst in extrahepatic ducts 13 years after liver hydatid endocystectomy. A case report

Objective:To describe a dog with Budd–Chiari‐like syndrome secondary to caudal vena cava compression from a thoracic wall chondrosarcoma.Case summary:A 9‐year‐old spayed female Shetland Sheepdog cross with a recent history of non‐productive cough developed severe abdominal distension and dyspnea. Marked ascites and enlarged hepatic veins were identified with ultrasonography. At surgery, a right thoracic wall mass was found to be compressing the caudal vena cava. Fluid analysis of the ascites revealed a modified transudate with elevated protein concentration, consistent with Budd–Chiari‐like syndrome. Clinical signs resolved following thoracotomy and complete resection of the mass.New or unique information provided:Obstruction of venous blood flow can result from compression exerted by a space‐occupying thoracic wall mass on the caudal vena cava. Clinical resolution can be achieved with return of adequate venous circulation by removal of the mass and alleviation of the external pressure.

Hydatid disease is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most commonly involved organ, the disease can be seen anywhere in the body. In the present study, we present our experience with uncommonly located hydatid disease diagnosed and treated between 1983 and 1999 in the Sixth Surgical Department of Ankara Numune Training and Research Hospital, Ankara, Turkey. Forty-nine patients with unusually located hydatid disease were retrospectively analysed. There were 21 men and 28 women in the present series. Of those, 26 patients were harbouring both hepatic and extrahepatic cysts, while 23 had only extrahepatic cysts. Peritoneal cavity, spleen, retroperitoneum, thyroid gland, anterior abdominal wall, thigh, kidney, presacral space and pancreas were the organs or tissues involved in the cases. Spleen and peritoneal cavity were the two most frequent locations in the present series. Partial or total cystectomy with or without tube drainage or omentopexy was the operation of choice for hydatid cyst of the peritoneal cavity. Splenectomy was performed for splenic hydatidosis. Mean postoperative stay was 7 days (4-23). Three diaphragmatic and one inferior vena cava lacerations occurred during operations that were repaired successfully in the same sessions. No mortality occurred in the present series. Hydatid disease can affect any organ or area throughout the body and suspicion of this disease should be justified in patients presenting with a cystic mass in endemic areas.

A hydatid cyst is a zoonotic infection which may affect any organ and tissue, particularly the liver and the lung. Primary muscular hydatid cysts comprise less than 0.7-3% of the cases. The hydatid cysts must be kept in mind to avoid a diagnostic puncture in cystic lesions to avoid the spreading of the disease. In this case report, we present an exceptionally rare case with an unusual localization of a primary hydatid cyst in the left deltoid muscle.