Unusual Presentation of Hydatid Cyst: A Case Series With Review of Literature

Abstract

Objective: The aim of this study was to evaluate the different presentations of hydatid cyst. The purpose of this article is to emphasize the fact that this disease should be suspected in cystic lesions affecting any organ in the body, especially in endemic areas of the world. Introduction: Hydatid cyst is the larval form of Echinococcus granulosus. Hydatid disease is endemic in India, as well as other parts of the world, including, Middle East, Africa, South America, New Zealand, Australia, Turkey and Southern Europe. Even though hydatid cysts can occur in any organ, it is very rare to see the disease in the sites reported in this article. In few cases though the sites are common, the way of presentation is very uncommon. Musculoskeletal hydatidosis is very rare. Material and methods: Twelve cases of Hydatid cyst at rare sites are being discussed. Case 1: A 60-year-old male patient presented with chronic distension of abdomen. On Computerised Tomography (CT), a cyst occupying the whole peritoneal cavity was present. Case 2: A 35-year-old man presented with two cystic lesions in the liver. Case 3: A 50-year-old male came with pain in abdomen since 10 days over right hypochondrium that aggravated on eating and had 2-3 episodes of vomiting. Ultrasonography (USG) and CT (Plain and Contrast) revealed a hydatid cyst in the liver with multiple daughter cysts. There was minimal hydatid fluid. Case 4: A 50-year-old male presented with pain in abdomen. On USG, there was a cystic lesion in the liver. Case 5: A 60-year-old man presented with pain in the right hypochondrium. USG and CT (Plain and Contrast) revealed a hydatid cyst in the liver. Case 6: A 30-year-female presented with complaint of left hypochondriac pain. CT showed multiple lobulated cystic mass in the inferior mediastinum and retroperitoneum. Case 7: A 53-year-old female presented with a swelling in the right loin region since 1 year. USG revealed a cystic lesion in the right kidney. Case 8: A 38-year-old man presented with an abdominal lump since 6 months. USG revealed a cystic lesion in the peritoneum. Case 9: A 75-year-old man admitted with painless swelling in the posterior aspect of the left thigh since 2 years. It was an intermuscular hydatid cyst. Case 10: A 35-year-female presented with swelling in posteromedial aspect of the thigh which radiologically revealed multiple cystic lesions. Case 11: A 43-year-old man presented with a swelling in the right supraclavicular region. Case 12: A 28-year-old female presented with a swelling in the right side of back. Radiology findings revealed a cystic lesion in the intramuscular plane.All the 12 cases were diagnosed histopathologically as hydatid cysts of respective sites. Results:A total of 12 cases were managed surgically. Out of 12 cases, 8 (66.66%) were male and 4 (33.33%) were female. The mean age of patients was 46 years. Incidence of hydatid cysts at various sites was: Five patients had hydatid cyst in the liver (41.66%), 2 patients in the thigh (16.66%), 1 patient each in the kidney, peritoneum, mediastinum, paraspinal and supraclavicular region (each 8.33%). Conclusion: Hydatid cyst of liver and lung is not uncommon, but it may present in an unusual manner in these usual sites. The possibility of hydatid cyst in any patient presenting as a soft tissue swelling should be kept as differential diagnosis as it can affect any organ of the body such as extremities and mediastinum.