Synchronus paraspinal and hepatic hydatid disease; A rare presentation

Abstract

Hydatid cystic disease is a common zoonotic infection in the Indian subcontinent. However in the following case we report a rare presentation found in a young patient synchronously in the paraspinal and intrahepatic location without intercommunication. A high index of clinical suspicion is necessary for diagnosis. Hydatid disease is to Echinococcus species commonly granulosus, sometimes multilocularis. The common locations of hydatid cysts are the liver (65% to 75%) and lungs (25%-30%). Hydatid disease rarely develops in locations such as spleen, kidney, bones, heart, brain, peritoneum, myocardium and muscles (1-4%). A 25 year old male presented with complaining of backache on the right and fullness in the right paraspinal region. On clinical examination he had a non ballotable lump in right paraspinal region within intra muscular plane extending from posterior subcostal margin to iliac region. CT abdomen (P+C) revealed a well defined hypodence non-enhancing cystic lesion in the right lobe of the liver with peripheral calcification with lesion of similar morphology in right paraspinal muscles. Exploration of the right paraspinal region was done. Cyst was beneath the oblique & lattisimus dorsi, superficial to psoas muscle without invasion in it. Cyst opened multiple daughter cysts along with pus evacuated. Cyst excised in totto without spillage. Hydatid cyst is frequently asymptomatic, most prevalent in sheep and cattle-breeding areas. The cysts can not easily grow in muscles due to their contractility and lactic acid content. The latent period of cyst development varies between 5-20 years. Surgery is the optimal treatment for hydatid cysts. Open cyst evacuation is indicated for gharbi types 4&5, posterior cysts, central cysts, more than 3 cysts, infected cysts, biliary communication, pulmonary communication & peritoneal rupture. Alternative therapy with non-toxic scolocidal agents or combination chemotherapy has been advocated in the management of recurrence and high risk of contamination.