Shape Misleading of Hydatic Cyst

doi:10.4236/ijcm.2013.48061

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International Journal of Clinical Medicine, 2013, 4, 347-349

http://dx.doi.org/10.4236/ijcm.2013.48061 Published Online August 2013 (http://www.scirp.org/journal/ijcm) 347

Shape Misleading of Hydatic Cyst*

M. Moujahid#, K. Chakoura, Y. Issaoui, I. Ennafae, M. Ghari, My. H. Tahiri

Department of General Surgery, 5th Military Hospital, Guelmim, Morocco.

Email: #[email protected]

Received February 5th, 2012; revised March 6th, 2012; accepted March 18th, 2012

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

The hydatidosis is a problem of public health in the zones of rising of the developing countries. It is an anthropozoonose

due to the development at the man of the larva of Echinococcus granulosis.The localizations at the man are varied,

unique or multiple, isolated or associated of which th e ch ief of thread is represented b y the liver and the lung . We report

a misleading revelation of the hydatic cyst of the psoas.

Keywords: Muscular Hydatic Cyst; Psoas; Unaccustomed Localizations; Diagnosis and Treatment

1. Introduction

The echinococcosis is a cosmopolitan antropozoonosis,

affecting the man and some mammals, connected to the

development in the body of the embryonic shape of a

tape worm of the dog called Echinococcus granulosis.

The muscular localization of the hydatid cyst is rare

and unusual even in the endemic countries. The clinical

symptom is aspecific, its diagnosis bases essentially on

the imaging. It is the disease which raises a real problem

of public health in our country. The muscular localization

occupies usually the fourth rank after the liver, lung and

the spleen location. The embryo hexacanthe has to cross

the liver and the lung which are important filters before

arriving at muscles. Besides the muscular fiber is the seat

of a contractility and a production of lactic acid, which

prevents the development of the parasite in the muscle.

This hydatidosis affects preferentially proximal muscles,

being this probably of in their wealth vascular with a big

blood flow at their level.

The muscular hydatidosis is a rare affection and the

effect of the psoas seems exceptional; even in coun try of

endemic disease.

The rarity of this localization and its clinical poly-

morphism make the interest of this study. We report a

hydatid cyst of psoas of a misleading revelation.

2. Observation

34-year-old Mr HB admitted in the service of neurosur-

gery on 7/12/2008 for a medical coverage of a right para-

vertebral collection in a feverish condition with lumbago

and a loss of weight calculated to 10 kg in two months

associated with a swelling of the iliac fossa and the right

inguinal fold (Figure 1).The spondylitis diagnosis of a

tubercular origin was recalled. The abdominal echogra-

phy showed a right co llection para verteb ral spread at the

crista iliaca. The pelvic abdomino scanner showed the

presence of a collection divided up in touch with the mu-

scle psoas and the right ilio psoas (Figure 2). The bio-

*Authors’ Contributions: Moujahid M and MY H Tahiri have inspired

the idea, collected the case, analysis and wrote most of the manuscript.

Chakuora K and Issaoui Y helped in collecting the data. Ennafae I and

EL Ghari have performed the sonography. All authors read and ap-

roved the final manuscript.

Competing interests: The authors declare that they have no competing

interests.

#Corresponding author. Figure 1. Mass of the iliac pit and the fold of the groin right.

Shape Misleading of Hydatic Cyst

348

Figure 2. Abdomino pelvic scan showing the presence of a

collection in the muscle psoas and the right ilio psoas.

logical balance sheet showed a hyperleukocytosis. BK

research in the spit and urine was negative as well as the

skin test in the tuberculin. The lung rad iography was nor-

mal. The diagnosis of an abscess of psoas was held and

the patient was sent to our service for medical care cov-

erage. He was operated with discovery of a hydatid cyst

of posas per operation spu rting out at the level of the ilio

psoas and at the level of the fold of the groin. After a

protection by fields soaked in the hydrogen peroxide and

the inhalation of the content of the cyst and cleaning by

serum and hydrogen peroxide. A pericystectomy was re-

vealed with a good clinical and radiological evolution.

The post surgery results were simple with a drop of 4

years without any sign of recurrence.

3. Discussion

The hydatidosis rag es in an en d emic way in certain coun-

tries of the Mediterranean Basin in Oceania and in South

America. It is a disease of the rural world in the tradi-

tional breeding ar eas. It is an anthr opozoon osis du e to the

development of Man’s larva of the taenia Echinococcus

granulosis.

The definitive host is represented by the dog; the man

integrates accidentally in the cycle of the parasite. Em-

bryonic eggs, eliminated from the exterior environment

with the saddles of the dog, are ingested, penetrate into

the digestive wall, through the liver, sometimes exceed

the hepatic veins and reach the lungs. Other unusual lo-

calizations were reported in particular the bone 1% - 3%,

pleura or peritoneum 4% - 7%, spleen and kidney 2% -

5%, brain 1% - 5%, heart 0.5% - 2% of the hydatic lo-

calizations [1]. More exceptionally the thyroid, the pan-

creas, the ovaries, the join ts, the mild parts subcutaneous

and muscular.

The skeletal muscle is the position of 1% of the hy-

datic localizations of man [2], the muscular localizations

reported are the diaphragm [3], the big pectoral muscle,

the brachial muscles, the sartorius [4] and the psoas mus-

cle [5-7] as in our case.

The muscle is generally very resistant in the hydatido-

sis because it tends to divide and encapsulate the larva as

well as the contractile activity and the production of lac-

tic acid [1,2,8].

On the clinical plan it is necessary to emphasize the

usual latency of the clinical symptoms, which appear as

sluggish tumefaction increasing in volume gradually,

sometimes by signs of compression or feigning another

pathology as pathological vertebral fracture or spondy-

litis [9,10] as it was the case of our patient.

The preoperative diagnosis is sometimes difficult be-

cause the biological examinations and the hydatic serol-

ogy are usually negative because of the encapsulation of

the larva. The radiography of the abdomen without pre-

paration can show an opacity falling on the axis of the

psoas and the disappearance of the external edge of this

muscle, Sometimes calcifications under forms of curvi-

linear border [3,5,6].

The echography and the scanner can direct the diag-

nosis by showing a fluid image more or less heterogene-

ous with sometimes a visualization of daughter cysts [1,3,

8]. Magnetic resonance imaging more precise in the de-

termination of the morphology, the topography and the

connections with the nearby structures in particular vas-

culo nervous [2,7]. The treatment is essentially surgical.

It is the only radical treatment allowing us to confirm the

diagnosis and to ensure a complete cure.

4. Conclusions

The hydatid cyst of psoas is a rare affection with slow

development which can take a misleading form. It is al-

ways necessary to think of it especially concerning the

persons living in a country with high endemic disease

and to ask for necessary complementary examinations to

make the diagnosis and avoid therapeutic errors.

The eradication of this affection requires prevention by

the sanitary education of the populations, the supervision

of the slaughter of animals, the treatment of the domestic

dogs by Praziquantel and the systematic euthanasia of

stray dogs.

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Shape Misleading of Hydatic Cyst

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