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Musculoskeletal » Abdomen
Hydatid Cyst of Abdominal Wall
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Author(s) :
Rajbala Godage, DMRD
Presentation A 19 year old female patient presented with a small, non tender palpable mass in the right lateral wall of the abdomen. An ultrasound of abdomen was performed.
Caption: Sagittal section of right lateral abdominal wall
Description: A small cyst ( 2.3 x 1.2 cm ), situated in right lateral wall of abdomen
Caption: Sagittal section of right lateral abdominal wall
Description: Cyst with daughter cyst and matrix within muscular plane of lateral abdominal wall
Caption: Transverse section of right lateral abdominal wall
Description: Cyst with daughter cysts within muscular plane of lateral abdominal wall
Differential Diagnosis The differential diagnosis of soft tissue cystic masses include abscess, chronic hematoma, necrotic soft tissue tumor and hydatid cyst
Final Diagnosis Hydatid cyst of lateral abdominal wall
Hydatid cyst is a parasitic infection caused by Echinococcus granulosus and Echinococcus multilocularis. Liver and lung are most commonly affected organs, but any part of body can be affected.

Primary hydatid disease of muscle accounts for <1% - <4% of the reported hydatid case.(1,2) It may be postulated that the low prevalence of this form of disease is potentially due to the physical barrier to hematogenous dissemination of cyst created by hepatic sinusoids and pulmonary capillaries. In addition, the growth of the cyst within a muscle is difficult because of contractility of muscle and presence of lactic acid.(3) The most common muscle sites include neck, pelvis, thigh and paravertebral musculature. This could be explained by increased vascularity and decreased activity of these muscles.

The Gharbi ultrasound classification consist of five stages(4):

Stage 1: homogenously hypoechoic cystic thin walled lesion
Stage 2: septated cystic lesion
Stage 3: cystic lesion with daughter lesions
Stage 4: pseudo-tumor lesion
Stage 5: calcified or partially calcified lesion ( inactive cyst )

In this case cyst was included in Stage 3.

Hydatid disease should be considered in differential diagnosis of cystic lesions of muscle because routine diagnostic procedures may not always be helpful.

The treatment of hydatid disease is excision of the intact cyst with surrounding tissue with adjunctive chemotherapy by albendazole.(1)

In this particular case, the muscular hydatid cyst was removed surgically.

Case References
1. Srinivas , Deepashri,Imaging Spectrum of Hydatid Disease: Usual and Unusual Locations, Pol J Radiol.2016; 81:190-205
2. Polat P et al,Hydatid disease from head to toe,radiographics 2003;23:475-494
3. K.Thursky,Primary Muscle Hydatidosis of Thigh , Clinical Infectious Diseases,2001;32:65-68
4. Gharbi H,Hassine W,Brauner M, Ultrasound examination of hydatid liver,radiology 1981;139:459-463
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