|Year : 2013 | Volume
| Issue : 4 | Page : 412-414
Infected primary hydatid cyst located in the Sartorius muscle
E Karakaş1, N Çullu2, N Altay3, IA Ozturk4
1 Department of Radiology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
2 Department of Radiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
3 Department of Anesthesiology and Reanimation, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
4 Department of Orthopedic Surgery, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
|Date of Submission||08-Mar-2013|
|Date of Acceptance||02-Aug-2013|
|Date of Web Publication||25-Sep-2013|
Department of Radiology, Faculty of Medicine, Harran University, Şanlıurfa
Source of Support: None, Conflict of Interest: None
Primary intramuscular hydatid cyst should be considered for the differential diagnosis of cystic soft tissue masses especially in the endemic areas though primary muscular hydatidosis is a rare clinical entity. We aimed to report the case of a 30-year-old female patient with infected primary intramuscular hydatid cyst located in the sartorius muscle.
Keywords: Hydatid cyst, infection, muscle
|How to cite this article:|
Karakaş E, Çullu N, Altay N, Ozturk I A. Infected primary hydatid cyst located in the Sartorius muscle. Indian J Med Microbiol 2013;31:412-4
|How to cite this URL:|
Karakaş E, Çullu N, Altay N, Ozturk I A. Infected primary hydatid cyst located in the Sartorius muscle. Indian J Med Microbiol [serial online] 2013 [cited 2019 Aug 22];31:412-4. Available from: http://www.ijmm.org/text.asp?2013/31/4/412/118878
| ~ Introduction|| |
Hydatid disease is a protozoal infestation, which predominantly involves liver and lungs mainly due to Echinococcus granulosus and rarely Echinococcus multilocularis.  Primary intramuscular hydatid cyst without any involvements of thoracic or abdominal organs is very rare and its reported incidence is between 0.5% and 5.4%. High lactic acid content and contractility limiting larvae residency are main mechanisms for the rarity of muscular hydatidosis. Primary intramuscular hydatid cyst should be considered in the differential diagnosis of intramuscular cystic soft tissue masses, especially in the endemic areas.  To the best of our knowledge, there have been limited cases of hydatid cysts in the Sartorius muscle. ,,, The case of infected primary intramuscular hydatid cyst located in the Sartorius muscle has not been reported yet. We report a case of infected primary intramuscular hydatid cyst located in the Sartorius muscle.
| ~ Case Report|| |
A 30-year-old female patient with complaint of an enlarging mass for 3 months and pain for a week in the superior-anterior part of right thigh admitted to our hospital. Physical examination revealed approximately 3 cm × 5 cm in size, erythema and increased warmth of the skin over the mass. Our patient was busy with the livestock including cattle and sheep in the village.
Ultrasonographic (US) assessment revealed thick-walled lobulated cystic lesion with a separated germinative membranes (water-lily sign) [Figure 1]. Magnetic resonance imaging (MRI) of the mass was performed to elucidate its location and relationship with the surrounding structures and to plan surgical strategy. MRI demonstrated an irregularly-bordered cystic lesion with dimensions of 19 cm × 28 cm × 57 mm located in the superior-anterior part of right Sartorius muscle, with lobulated shape involving images of separated germinative membranes (water-lily sign) with peripheral contrast involvement and surrounding signal changes representative of oedema and inflammation [Figure 2]. No other foci of hydatid disease were determined in the scan for lungs and liver. Laboratory tests showed no abnormalities except for an increase in total leukocyte count.
|Figure 1: The right thigh US image of a 30‑year old female. Ultrasonographic image shows thick‑walled lobulated cystic lesion with a separated germinative membranes|
Click here to view
|Figure 2: Magnetic resonance imaging of the right thigh. Coronal fat‑sat TSE T2 weighted (a) and coronal TSE T1 weighted (b) images show an irregular‑bordered cystic lesion located in the superior‑anterior part of right sartorius muscle, with lobulated shape involving images of separated ger‑minative membranes. Axial (c) and coronal (d) fat‑sat contrast‑enhanced T1‑weighted images show the cystic lesion with peripheral contrast involvement and surrounding signal changes representative of oedema and inflammation|
Click here to view
Based on the findings, we presumed infected primary intramuscular hydatid cyst. Infectious findings regressed in preoperative two weeks with antibiotic therapy. She underwent surgery with presumptive diagnosis of primary infected hydatid cyst [Figure 3]. The patient was treated with albendazole 10 mg/kg daily in two divided doses after food for 1 week prior to surgery and the same dose of albendazole was continued to prevent recurrence for 3 months following surgery. Pathological examination confirmed the diagnosis of primary intramuscular hydatid cyst and the species of Echinococcus was found to be E. granulosus by using the Euroimmun Western blot kit. No recurrence of hydatid disease was observed with a mean follow-up of 1 year.
|Figure 3: Surgical picture (a) and gross pathologic specimens (b and c) of resected hydatid cyst in the Sartorius muscle|
Click here to view
| ~ Discussion|| |
Hydatid cyst is a parasitosis caused by E. granulosus in 99% of the cases while E. multilocularis is responsible for 1% of cases. Humans are coincidental intermediate hosts in the infestations caused by Echinococcus species. In its adult stage, the parasite resides in the bowels of carnivorous animals, which are the main hosts, and the larvae of E. granulosus spread with faeces of these animals. Intermediate hosts are infected via gastrointestinal tract through larval penetration of duodenal wall, and spread all tissues via circulation.  Tissue involvement of hydatidosis are as follows; liver 50-70%, lungs 11-17%, soft tissues 2.4-5.3%, pericardium 5% and muscle and subcutaneous tissues 0.5-4.7%.  Although rare, primary intramuscular hydatid cyst should be considered for the differential diagnosis of cystic soft tissue masses located in the muscle, especially in the endemic areas. 
US should be the first-line imaging method for hydatid cysts located in the soft tissue. US can reveal the type, location and size of the cyst. If daughter vesicles and water-lily sign are seen, it can reach approximately 100%.  MRI is the best method for assessing the size and appearance of the cyst, making differential diagnosis, detecting the relationship with the surrounding tissues and for aiding in planning surgery.  Imaging findings of the present case were consistent with the literature  as MRI revealed better diagnostic findings for primary infected intramuscular hydatid cyst although strongly suggestive findings for primary hydatid cyst were present on US.
Diagnostic biopsy or aspiration should be avoided when intramuscular hydatid cyst is suspected to prevent rupture or spread of the disease, which would further lead to spread to other organs or anaphylaxis.  Combined radical surgery and antihelminthic therapy are the cornerstones for hydatidosis,  as was in our case.
| ~ Conclusion|| |
Primary intramuscular hydatid cyst should be considered for the differential diagnosis of cystic soft tissue masses in the endemic regions though it is a rare involvement. Biopsy or aspiration should not be done to prevent rupture or spread of the disease, so specific US and MRI findings are important.
| ~ References|| |
|1.||Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004;17:107-35. |
|2.||Tatari H, Baran O, Sanlidag T, Gore O, Ak D, Manisali M, et al. Primary intramuscular hydatidosis of supraspinatus muscle. Arch Orthop Trauma Surg 2001;121:93-4. |
|3.||Duygulu F, Karaoğlu S, Erdoğan N, Yildiz O. Primary hydatid cyst of the thigh: A case report of an unusual localization. Turk J Pediatr 2006;48:256-9. |
|4.||Comert RB, Aydingoz U, Ucaner A, Arikan M. Water-lily sign on MR imaging of primary intramuscular hydatidosis of sartorius muscle. Skeletal Radiol 2003;32:420-3. |
|5.||Daali M, Hssaida R. Muscle hydatidosis. 15 cases. Presse Med 2000;29:1166-9. |
|6.||Vietri F, Illuminati G, Palumbo P, Guglielmi R. Recurrent primary hydatidosis of sartorius muscle: Case report. Acta Chir Scand 1988;154:535-6. |
|7.||Essadki O, el Hajjam M, Kadiri R. Hydatid cyst of soft tissues. Radiological aspects. Ann Radiol (Paris) 1996;39:135-41. |
|8.||Yorukoglu Y, Zengin M, Dolgun A, Nazliel K, Salman E, Pasaoglu E, et al. Primary muscular hydatid cyst causing arterial insufficiency: Case report and literature review. Angiology 1993;44:399-401. |
|9.||Haque F, Harris SH, Khan R, Abbas SZ. Primary hydatidosis of gluteus maximus. J Postgrad Med 2006;52:300-1. |
|10.||Cretu CM, Codreanu RR, Mastalier B, Popa LG, Cordos I, Beuran M, et al. Albendazole associated to surgery or minimally invasive procedures for hydatid disease: How much and how long. Chirurgia (Bucur) 2012;107:15-21. |
[Figure 1], [Figure 2], [Figure 3]