Case: Hydatid cysts
Reported by Bharat Kelkar, Hospital for Orthopaedic and Reconstructive Surgery, India
35 yr old male complains of pain in right leg with soft swelling in the upper third region, nil distal neurovascular. X-ray shows extra osseous lesion scalloping on upper tibia laterally. Sonography shows multiple cystic lesions suggesting hydatid cysts.
MEDLINE shows that this is rare occurrence, but does not mention whether the excision also requires formalin wash.
Below are x-ray and images of the hydatid cysts removed at surgery.
From: Mehmet Arazi, MD
Hydatid disease of the bone and soft tissue of the musculoskeletal system is uncommon. Turkey is an endemic area of the disease, too. Therefore we treated some patients affected the disease. We reported two articles about this (1,7). Recently, a spinal case has been published in Orthopedics (1).
It leads to many diagnostic and therapeutic problems. Because early diagnosis of the disease is difficult, the patients often are admitted to the hospital when the disease is advanced and widespread. Therefore, treatment failure not unusual. Recurrence is common.
I suggested radical extensive resection of the lesion and albendazole medication, after surgery. Recently successful clinical results have been reported with albendazole (3,7,15).
For bacterial superinfection, broad-spectrum antibiotics (such as cephalosporins) should be administered following radical excision. I also suggest some references may be useful.
Mehmet Arazi, MD
Department of Orthopaedics and Traumatology
Selcuk University, Medical School
Konya, 42080, Turkey
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