Evaluation of musculoskeletal hydatid cyst cases in terms of clinical manifestations, method of dealing, treatment, and recurrence

Abstract

Hydatid disease is one of the most common parasitic diseases caused by Echinococcus granulosus worm. In this disease, involvement of all organs is likely. However, primary hydatid cysts of muscle tissue are so rare that occasionally in differential diagnosis, cystic masses are not placed in endemic areas. Timely and accurate diagnosis is crucial to prevent unnecessary biopsy. In this case-series study conducted in hospitals of Semnan and Tehran, Iran, from 2009 to 2014, 15 patients with musculoskeletal problems due to hydatid cyst were evaluated. In each case, information about the patient’s clinical manifestations, including initial complaint, cyst location, treatment method, location of involvement organ, duration, dose of drug used and diagnostic method was evaluated. According to results of the present study, the prevalence of musculoskeletal system involvement was 7.21%. The most common site of involvement was spine and paravertebral muscles (7 cases) and the most common symptom was compressive symptoms on the spinal canal. Magnetic resonance imaging was the most commonly used diagnostic method and only in 1 case a wrong pre-operative diagnosis was made. Eleven patients reported a history of recurrence at the site of previous surgery (3 cases of hip involvement and 6 cases of spine involvement). There were 5 cases of recurrence following recent treatment, 2 of which were hip involvement and 2 cases of spine involvement. Furthermore, most patients (12 cases) underwent cyst resection surgery. The results of this study showed that although hydatid cystic skeletal muscle is rare, due to the possibility of repeated recurrence, especially in cases of spine and bone involvement, endemic areas should be considered in the differential diagnosis of each cystic mass of muscle and bone.