SONOWORLD : Hydatid Cyst Ultrasound

Username

Password

177,065 Registered Members as of 10/23/2019.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Musculoskeletal » Superficial

Hydatid Cyst of the Groin and Thigh

« Back to Listing

Author(s) :

Sorin Dudea, MD, PhD

Carolina Botar-Jid, MD

Dana Dumitriu, MD

Constantin Ciuce, MD

Presentation A 60-year old male patient presented with a large non-tender palpable mass located in the groin and the anterior compartment of his right thigh. An ultrasound of the thigh and of the abdomen was performed.

Caption: Sagittal section of the anterior compartment of the right thigh

Description: A large multiloculated cyst (13/11.4/10.8 cm), situated posterior to the sartorius muscle.

Caption: Transverse section of the anterior compartment of the right thigh.

Description: The typical aspect of daughter cysts within the cyst.

Caption: Sagittal section of the liver

Description: A well-defined, partially calcified inhomogenous mass, measuring 7/7.5 cm, is seen in the right lobe of the liver

Differential Diagnosis The differential diagnosis of soft tissue cystic masses should include synovial cyst, abscess, chronic hematoma, as well as necrotic soft tissue tumors and hydatid cysts.

Final Diagnosis Hydatid cyst of the groin and thigh

Discussion Hydatid cysts occur most commonly in the liver (75 % of cases) and lung (15-24%), but any part of the body can be affected. Other abdominal organs may be involved in approximately 4% of cases, while soft tissue and bone are affected in only 1-2.4% of cases. [1, 2]
Primary hydatid disease of the muscle is very rare; generally, hydatid cysts are secondary to a hepatic or pulmonary lesion which leads to hematogeneous spread of the parasites. It is also possible for a retroperitoneal cyst to spread toward the lower extremity, much like a cold abscess of the psoas muscle. [2] The most common musculoskeletal locations are the neck, the trunk and the root of the extremities, probably because of their rich vascularization. [2, 3] It is uncommon for cysts to grow to very large sizes in the muscle, because of the high concentration of lactic acid and the contractility of the muscle. [2] However, in this particular case the cyst reached an impressive size – 13 cm in diameter.
Ultrasound may identify the cyst and it may also include it into one of five types, according to Gharbi. [4] In this case, the cyst in the thigh was included in type III: cyst with daughter cysts and matrix, whereas the cyst in the liver was considered type V: calcified cyst.
Sometimes the sonographic differential diagnosis can be difficult, especially when the mass does not present as a typical cystic lesion with daughter cysts. In such cases, MRI has proven helpful, as it identifies a peripheral hypointense rim which has been described as specific for hydatid cysts [5], but which is not always present. [3]
The treatment of hydatid disease may be surgical or interventional. In this particular case, the muscular cyst was removed surgically; no intervention on the hepatic cyst was considered necessary, because its ultrasound aspect suggested calcification and inactivity.
This case was considered interesting since, according to a search that we conducted, there are less than forty cases of muscular hydatid cyst of the extremities reported in literature.

Case References

Polat P et al, Hydatid disease from head to toe, RadioGraphics 2003; 23: 475-494.
Engin G, Acunas B, Rozanes I, Acunas G, Hydatid disease with unusual localization, Eur Radiol 2000; 10:1904-1912.
Garcia-Diez AI et al, MRI evaluation of soft tissue hydatid disease, Eur Radiol 2000; 10:462-466.
Gharbi H, Hassine W, Brauner M, Dupuch K, Ultrasound examination of the hydatic liver, Radiology 1981; 139:459-463.
Memis A, Arkun R, Bilgen I, Ustun E, Primary soft tissue hydatid disease: report of two cases with MRI characteristics, Eur Radiol 1999; 9:1101-1103

Follow Up The surgical intervention confirmed the ultrasound diagnosis: the cystic lesion of the right thigh was a hydatid cyst.

Other contents by this AuthorOther Cases in This Category

Musculoskeletal >> Superficial

Retained foreign body in the soft tissues of the forehead
Young female involved in a car accident about a month ago. Her head had crashed through the windshield. She now presents with painful swelling along her left lateral forehead.

Abdominal wall hemangioma
A month old neonate presented with anterior abdominal mass and was referred for an ultrasound.

Left supraumbilical hernia
A 50 year old obese woman with history of multiple abdominal surgeries reports a left abdominal wall swelling of one month duration. This was directly superior to a midline abdominal incision. ...

Retained foreign body in the hand
A woman presents with history of recurrent abscess formation and pain in right hand. She had a history of glass injury two months ago.

Necrotizing infection in the soft tissues of right ankle
A diabetic patient presented with redness and swelling around the right ankle. He also had a necrotic ulcer along the medial aspect of the right ankle. A clinical diagnosis of cellulitis was made ...

Infective inguinal lymphadenitis
A 35-year-old man presents with a mass in the right inguinal area. Multiple lymph nodes could be palpated clinically. An ultrasound of the right inguinal region was performed.

Left cheek hemangioma
A 17-year-old boy presented with a swelling / asymmetry of his left cheek since birth. The swelling increased when he leaned forward and when he lay on that side & reduced when he was erect. On ...

Foreign body: glass piece in the right foot
An ultrasound evaluation of the foot was performed following patient complaints of stepping on broken glass.

Abscess in the anterior triangle of the neck
A 3-year-old girl presents with a painful lump in the left upper neck, fever and elevated WBC counts. An ultrasound of the neck was performed.

Inguinal hernia
A middle-aged man presents with a history of a bulge in the right inguinal area while coughing. An ultrasound of the right inguinal region was performed.

Nonreducible inguinal hernia containing the right ovary
Four weeks old girl with a palpable mass in the right groin

Glomus tumor under the nail of the thumb
14 year old female patient with pain in the thumb during compression of the nail

Enlarged thymus in the neonate
An ultrasound of the chest was done in this one-month-old baby for suspicious upper lobe consolidation.

Gluteal muscle hematoma in a patient with hemophilia
A young male, with history of hemophilia A, presented with sudden onset pain in the left gluteal region of 2 days duration. He is afebrile; there is no history of trauma. Physical examination ...

Bilateral postoperative rectus sheath hematoma
This is the scan in a 70-year-old woman with a right painful lump. She is status post hernia repair, performed a year ago. A focused anterior abdominal wall scan was performed.