HYDATID CYST OF THE THIGH

Khalfallah Mehdi |

La tunisie chirurgicale - 2019 ; Vol 2019

Resumé

The existence of hydatid cysts in unusual locations has been reported.Hydatid cysts of limbs remain very rare (1 to 5%)[1]. Their often asymptomatic nature andtheir slow evolving make diagnosis late.

We report a case of hydatid cyst of the thigh revealed by a cutaneous swelling evolving in the

shape of anthrax.

Mots Clés

HYDATID CYST OF THE THIGH

Introduction :

The existence of hydatid cysts in unusual locations has been reported.Hydatid cysts of limbs remain very rare (1 to 5%)[1]. Their often asymptomatic nature andtheir slow evolving make diagnosis late.

We report a case of hydatid cyst of the thigh revealed by a cutaneous swelling evolving in the

shape of anthrax.

Article

 

OBSERVATION :

Miss G.N, aged 19 , with no medical history, had consulted for a painful swelling of the front

of the left thigh , progressively increasing in size and evolving for one month. Upon

examination, she was afebrile and had a 5 cm tumefaction of long axis of the higher third of

the front part of the left thigh , which was painful, fluctuating, with 4 puncture wounds in its

centre letting pus seep out. Biology did not show either hyperleucocytosis or rise in

C- reactive protein . The diagnosis of thigh anthrax had then been retained and the patient was

operated on. Intraoperatively, it seemed that it was a hydatid cyst with crystal clear fluid

content and several daughter cysts and hydatid membranes (figures n°1 and 2).

Figure n°1: picture taken intraoperatively showing daughter cysts (single arrow )

andpericystium (double arrow)

 

 

Figure n°2: daughter cysts and hydatid membranes

 

A total perikystectomy had been performed , removing the whole cyst .Post-operative course was uneventful.Further exploration through a thoracic-abdominal-pelvic CT scan to look for other hydatidlocations was normal. The patient was examined again 15 days later and the wound wasfound clean and healing.

DISCUSSION:

Muscle hydatidosis is rare [1]. This infrequency can be explained first by the the life cycle of

the parasite, which , taking the portal system, is stopped in 80 % of cases at the level of the

liver and lungs. The local phenomena specific to muscles then prevent the implantation and

growth of the parasite. Actually, the contractility of the muscular tissue and the production of

lactic acid , a toxic element for the parasite, prevent this development.

Muscle hydatidosis affects preferably big muscles on account of the volume of the muscle

mass and their rich vascular system. The primitive and isolated nature is another special

feature of this kind of location in most published reports and in the case we are reporting.

The clinical picture is not too specific and can be summed up in a painless , non-inflammatory

swelling with good overall physical condition. In case of cracking or superinfection , the cyst

can simulate an abcess or a malignant tumor. The hydatid serology is often negative but it is

more useful in the postoperative supervision of a local or distant recurrence of the hydatid

disease. The ultrasound scan is the reference investigation: it allows to make a positive

diagnosis, to specify the site, size and number of cysts [2]. CT scan and MRI are indicated in

doubtful cases ,pseudotumoral cysts ,and to specify connections with neighbouring

vasculonervous elements [2]. The preoperative diagnosis must be confirmed ahead of any

puncture, biopsy or resection , lest we spread the cyst content , cause an anaphylactic allergic

shock and in order to protect the operating field with a scolicide solution [3]. The treatment is

exclusively surgical and consists in most cases in a total perikystectomy removing the whole

cyst to find healthy tissue. The cysts developped on contact with vasculonervous axes will be

treated by subtotal pericystectomy which leaves a flange of the pericyst in contact with noble

elements , or by resection of the projecting dome with large drainage of the residual cavity

[4]. The medical treatment with imidazole derivatives has no place in practice in the treatment

of muscle hydatidosis although it seems quite efficient in inoperable cases or as a complement

to surgery [5].

Post-operative follow-up is based on physical examination, hydatid serology and imaging

(ultrasound scan of soft tissues).

CONCLUSION:

Hydatidosis is endemic in Tunisia. Muscle hydatidosis is a rare location and affects

preferably proximal limb muscles. Ultrasound scan is a key medical examination in positive

diagnosis. The treatment of choice is radical resection of the cyst. The prevention of

hydatidosis remains the best treatment.

 

Conflict of interest:

No conflict of interest

 

Références

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of soft tissue hydatid disease. EurRadiol2000;10:462-6.

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le kyste hydatique des parties molles: J Radiol 2005; 86: 1589.

3 : J.A. Guthrie, J.O. Lawton, A.G. Chalmers. Case report: The MR appearances of primary

intramuscularhydatiddisease, Clin. Radiol. 1996;51: 377-9.

4 : T. Hammami,F.Noomane, M. Ketata,, Y. Ganneme M. Nasr, K. Zouari A. Hamdi. Kyste

hydatique musculaire de la cuisse, à propos de trois observations; RevChirOrthopTraumatol

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