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Osseous Hydatidosis

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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.

Comments

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
Assistant Professor
Department of Orthopaedics and Traumatology
Selcuk University, Medical School
Konya, 42080, Turkey
Email: marazi19@hotmail.com

References

  1. ArazI M, MemIk R, Kapicioglu MI. Answer please. Hydatid disease of the spine. Orthopedics 1998 21(8):912,909-910.
  2. Agarwal S,  Shah A, Kadhi SKM, Rooney RJ: Hydatid disease of the pelvis. Clin Orthop  1991; 280:251-255.
  3. Szypryt EP,  Morris DL, Mulholland RC: Combined chemotherapy and surgery for hydatid bone disease. J Bone Joint Surg 1987; 69B(1):141-144.
  4. Alldred AJ, Nisbet NW: Hydatid disease of bone in Australasia. J Bone Joint Surg 1964; 46B(2):260-267.
  5. Booz MK: The management of hydatid disease of bone and joint. J Bone Joint Surg 1972; 54B(4):698-709.
  6. Duran H, Fernandez L, Gomez-Castresana F, et al:  Osseous hydatidosis. J Bone Joint Surg 1978; 60A:685-690.
  7. Saglýk Y, Memik R, Özbarlas S, Kapicioglu S, Demirtas M: Idatidosi Dell’osso (Hydatid disease of bone). Giorn Italian Orthop Trauma 1994; XX(2):281-287. Italian.
  8. Markasis P, Markaki S, Prevedorou D, Bouropoulou V: Echinococcosis of  bone: clinicolaboratory findings and differential diagnostic problems. Arch Anat Cytol Path 1990; 38:92-94.
  9. Rao S,  Parikh S,  Kerr R: Echinococcal infestation of the spine in North America. Clin Orthop 1991; 271:164-169.
  10. Torricelli P, Martinelli C, Biagini R, Ruggieri P, De Cristofaro R: Radiographic and computed tomographic findings in hydatid disease of bone. Skeletal Radiol 1990; 19:435-439.
  11. Rong SH, Nie ZQ:  Hydatid disease of bone. Clin. Rad 1985; 36:301-305.
  12. Bellini MA: Osteohydatidosis: its radiological features. Radiology 1946; 47:569-574.
  13. Beggs I: The radiology of hydatid disease. AJR 1985; 145:639-648.
  14. Ocete G, Guerrero A, Diaz-Peletier R, Burgos J, Bouza E, DeMiguel C: Experience in the treatment of osseous hydatidosis. International  Orthop (SICOT) 1986; 10:141-145.
  15. Saimot AG, Cremieux AC, Hay JM, et al: Albendazole as a potential treatment for human hydatidosis. Lancet 1983; ii:652-656.

Bibliography

Savas R, et al. Spinal cord compression due to costal Echinococcus multilocularis. Comput Med Imaging Graph. 1999 Mar-Apr;23(2):85-8.

Kabbaj-El Kouhen N, et al. Isolated lumbar intradural hydatid cyst. J Radiol. 1999 Feb;80(2):147-9. French.

Briant JF, et al. Osteoarticular involvement in parasitic diseases: bone echinococcosis. J Radiol. 1998 Nov;79(11):1351-7. Review. French.

Pau A, et al. Computed tomography and magnetic resonance imaging in spinal hydatidosis.  Surg Neurol. 1987 Apr;27(4):365-9.

Fahl M, et al. Magnetic resonance imaging in intradural and extradural spinal echinococcosis. Clin Imaging. 1994 Jul-Sep;18(3):179-83.

Campesi G, et al. Unusual reactional mechanisms of the bone in echinococcosis. Riv Anat Patol Oncol. 1967 Mar;31(3):Suppl:31-5. Italian.

Bairak VG, et al. Diagnosis and treatment of echinococcosis of the bones. Sov Med. 1987;(3):102-4. Russian.

Bondiau PY, et al. Bone hydatidosis. Pseudosarcomatous aspect. Presse Med. 1993 Oct 2;22(29):1367. French.

Rusakov AB. On the diagnosis and treatment of echinococcosis of the bone. Ortop Travmatol Protez. 1967 Jan;28(1):68-70. Russian.

Morano JU, et al. Radiologic seminar CCXII: bone involvement in echinococcosis. J Miss State Med Assoc. 1981 Mar;22(3):55-7.

Oueslati A, et al. Bone echinococcosis. Apropos of 4 cases. Tunis Med. 1987 Apr;65(4):291-7. French.

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