Primary chest wall hydatidosis
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Primary Chest Wall Hydatidosis Case Report A. Ninos, A. Papaevangelou, E. Papakonstantinou, S. Maletsikopoulos, L. Palivos, M. Vidali, P. Antonakas, Ch. Farazi, J. Papandrikos, S. Pierrakakis Received 12/07/2010 Accepted 27/09/2010
Abstract Background: Primary involvement of muscles is very rare in cases of hydatidosis. Even rarer is a primary hydatid cyst of the thoracic chest wall. Case report: A 50-year-old man was admitted to our hospital with a semimobile and well-circumscribed mass at the 6th intercostal space. He had a history of excision of a hydatid cyst at the same location three years earlier. A CT scan revealed a multivesicular cystic mass. Despite having negative antibody titers, he was given a preoperative course of alvendasole. The cystic mass was excised intact. He received two more cycles of alvendasole postoperatively. Conclusions: A multiloculated mass in the thoracic chest wall may well represent a hydatid cyst. A radiographic confirmation obviates the need for further manipulation until the definitive surgical resection
Keywords
Primary hydatidosis, Soft tissue hydatidosis, Chest wall hydatidosis
Introduction Hydatidosis is a zoonosis caused, in the majority of cases, by echinococcus granulosus. The location of the hydatid cyst is mostly hepatic and/or pulmonary[1]. With an incidence of less than 5%, primary involvement of muscles is very rare [2]. Reports of primary hydatidosis of the chest wall in the English literature are also scarce [3].
Case report A 50-year-old man presented in our outpatients department for evaluation of a small round lump in his right chest. His history included the excision of a small mass in the same region three years earlier, which was diagnosed as a hydatid cyst. He did not receive any medical treatment on that occasion. Thriassion General Hospital, Athens, Greece Department of Surgery Department of Pathology Radiology Department e-mail: [email protected]
No more detailed, formal information could be obtained. A physical examination revealed a smooth semimobile mass protruding through a lower intercostal space. A chest computerized tomography identified a bubble-like, oval, circumscribed lytic lesion in the 10th right rib with virtually no sclerotic reaction. There was also an expansion of the rib (Figs 1, 2a,b). An adjacent soft tissue multilocular cystic mass was shown, consistent with a hydatid cyst, in his 9th right intercostal space. An antibody test proved negative. Due to his previous history and confirmative scanning results, he received a preoperative 28-day course of oral albendazol. Surgical resection included the intact cystic mass, contained in the 9th intercostal space, without invading the pleural space (Figs 3, 4). There was also a marginal destruction of the neighboring rib with virtually no sclerotic reaction. Histology confirmed the diagnosis of a hydatid cyst. He received two more 28-day sequences of albendazole postoperatively. A year after surgery, the patient remains asymptomatic and without any clinical signs of recurrence.
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