SESSION TITLE: Infections Global Case Reports
SESSION TYPE: Global Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Even though it’s known since the time of Hippocrates, Hydatid disease or Echinococcosis caused by the larval form of the cestode Echinococcus granulosus is a major public health problem in even today. It is still endemic zoonotic infection in some areas of the world including Mediterranean countries, the Middle East, India, Africa, South America, Australia and New Zealand where prevalent in most sheep and cattle raising countries . Although the most frequent localization of first two places are the liver (75%) and lungs (15%), hydatid disease could be anywhere in the body. Intramuscular hydatid cyst that usually affects a single muscle is extremely rare due to the high lactic acid concentration in skeletal muscle and to mechanical factors such as contractile activity and be liable for less than 1% of all locations .
CASE PRESENTATION: A 64-year-old man was admitted to our hospital with a six months history of a painless slowly enlarging mass in his left hemithorax. Upon physical examination, there was a 6 x 4.5 cm, non-tender, mobile, smoothly outlined mass on the left latissimus dorsi muscle. Laboratory tests were normal. Thorax Computerized Tomography (CT) scans showed two cystic pulmonary nodules in the right inferior lobe. Additional radiological assessments revealed no other organ involvement.The patient underwent two-step surgery. The first step was excision of the cyst in his left hemithorax. Next step involved cystectomy plus capitonnage performed on the lung lesions through the right posterolateral thoracotomy. Both surgical interventions were carried out with the patient in the lateral decubitus position. Diagnosis was verified with histopathological examination. After operation medical treatment with albendazole (10 mg/kg/ daily) for three months was recommended.
DISCUSSION: Hydatid cyst requires two hosts for completion of its life cycle. The carnivores (dogs, wolves etc) are the definitive hosts, harbouring mature tape worms in their intestines. The herbivores (sheep, cattle etc) act as intermediate hosts who ingest the eggs from which the embryos escape, penetrate the intestinal mucosa, enter the portal circulation and are then trapped in liver and lungs. Therefore, nine-tenths of the cases are in the liver and lung involvement. The life cycle is over when the carnivores eat the infected offal of the intermediate host. Casual host mankind is essentially dead-end for the parasite. A few cysts can escape into the circulation; however, in only 10% of all cases, it is responsible for the rare localization including spleen, pancreas, gallbladder, adrenal gland, pelvis, seminal vesicle, heart, bone, breast, kidney, thyroid gland and soft tissues. Even though different hypotheses have been put forward about the way of transmission and pathogenesis of the rare localizations of hydatid cyst; it remains unclear and controversial; one of these theories is shunt-escape theory that greatly accepted [1-3], as we participate in.
CONCLUSIONS: In conclusion, to our knowledge; there have been very few reports of intramuscular hydatidosis latissimus dorsi involvement. Hydatid disease can be found in any skeletal muscle as could be anywhere in the body. It should be kept in mind in differential diagnosis of all soft tissue lesions even though they located in muscle particularly in endemic zones such as Turkey
Reference #1: Safioleas M, Nikiteas N, Stamatakos M, Safioleas C, Manti CH, Revenas C, Safioleas P. Echinococcal cyst of the subcutaneous tissue: a rare case report. Parasitol Int. 2008 Jun;57(2):236-8.
Reference #2: Jerbi Omezzine S, Abid F, Mnif H, Hafsa C, Thabet I, Abderrazek A, Sassi N, Hamza HA. Primary hydatid disease of the thigh. A rare location. Orthop Traumatol Surg Res. 2010 Feb;96(1):90-3.
Reference #3: Vecchio R, Marchese S, Ferla F, Spataro L, Intagliata E. Solitary subcutaneous hydatid cyst: review of the literature and report of a new case in the deltoid region. Parasitol Int. 2013 Dec;62(6):487-93.
DISCLOSURE: The following authors have nothing to disclose: Mihrican Yesildag, Mustafa Calik, Saniye Calik
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