AN UNUSUAL CASE OF AN UNUSUAL CASE OF HYDATID CYST IN THE HYDATID CYST IN THE THIGHTHIGH

*Dr.(prof)A.K.Sharma(MS)

**Dr.Gambheer Singh(MS)

***Dr.Rajan Kumar

INTRODUCTIONINTRODUCTION

35 years old male 35 years old male patientpatient

Palpable mass in Palpable mass in right upper thigh in right upper thigh in posteromedial posteromedial aspectaspect

Duration – 12 yearsDuration – 12 years Pain since 1 monthPain since 1 month No H/O animal No H/O animal

contactcontact

Solitary swellingSolitary swelling 8x9 cm ovoid in shape8x9 cm ovoid in shape Soft to firm in consistencySoft to firm in consistency Non tenderNon tender Smooth surfaceSmooth surface Overlying skin was normalOverlying skin was normal Well defined marginWell defined margin No impulse on coughingNo impulse on coughing No pulsation.No pulsation.

O/E:-O/E:-

MobilityMobility

FluctuationFluctuation TransilluminationTransillumination PercussionPercussion auscultationauscultation

Freely mobile in Freely mobile in relaxed positionrelaxed position

Restricted on Restricted on muscle contractionmuscle contraction

AbsentAbsent AbsentAbsent DullDull No bruit,no thrillNo bruit,no thrill

O/E (contd.)O/E (contd.)

Differential DiagnosisDifferential Diagnosis

RhabomyosacromaRhabomyosacroma LipomaLipoma LiposarcomaLiposarcoma NeurofibromaNeurofibroma Hydatid cystHydatid cyst

INVESTIGATIONSINVESTIGATIONS

Routine lab Routine lab investigationinvestigation

Eosinophil countEosinophil count FNACFNAC USG lump right USG lump right

thighthigh

With in normal limitWith in normal limit

With in normal limitWith in normal limit InconclusiveInconclusive a fusiform lesiona fusiform lesion multiple variable multiple variable

sized cysts with in itsized cysts with in it well defined well defined

capsulatedcapsulated intramuscularintramuscular

OPERATIONOPERATION

F/S/O hydatid cyst F/S/O hydatid cyst right thighright thigh

surgery was plannedsurgery was planned complete excision of complete excision of

well encapsulated well encapsulated intramuscular cystic intramuscular cystic lump done with lump done with preservation of all preservation of all important vessel, important vessel, nerves and musclesnerves and muscles

Gross ExaminationGross Examination

Microscopic ExaminationMicroscopic Examination

HistopathologyHistopathology

On gross examination, there were On gross examination, there were multiple daughter cysts were present with multiple daughter cysts were present with in the mother cysts, hydatid fluid and in the mother cysts, hydatid fluid and sand were present.sand were present.

On histological examination it is On histological examination it is consistent with features of HYDATID consistent with features of HYDATID CYSTCYST

Post operative period – uneventfulPost operative period – uneventful Patient - discharged after removal of all Patient - discharged after removal of all

stitchesstitches Wound - healthy Wound - healthy Advise – to take mebendazole for 4 Advise – to take mebendazole for 4

weeksweeks

Post-operative EventPost-operative Event

Bayram and siricki reported the 1st Bayram and siricki reported the 1st intermuscular hydatid cysts in forearm intermuscular hydatid cysts in forearm region of 18 year old manregion of 18 year old man

More than 90% of hydatid cysts occur in More than 90% of hydatid cysts occur in the liver, lungs, or both.the liver, lungs, or both.

Peripheral organ hydatidosis is much Peripheral organ hydatidosis is much less commonless common

Few embryos can escape the capillary Few embryos can escape the capillary filtering systems of the liver and lung.filtering systems of the liver and lung.

Primary hydatid disease of the skeletal Primary hydatid disease of the skeletal musclemuscle

1.1. RareRare

2.2. In 3% of patients. In 3% of patients.

3.3. Muscle is inhospitable for echinococcal Muscle is inhospitable for echinococcal interactions because of its contractility interactions because of its contractility and high level of lactic acidand high level of lactic acid..

Most of the previous reports of primary Most of the previous reports of primary muscular hydatidosis have been isolated muscular hydatidosis have been isolated intramuscular localizationsintramuscular localizations

Preoperative diagnosis and evidence of Preoperative diagnosis and evidence of

diagnostic biopsy or aspiration is crucial diagnostic biopsy or aspiration is crucial in preventing local recurrence, cystic in preventing local recurrence, cystic infection, and anaphylactic shockinfection, and anaphylactic shock..

Sensitivity of serologySensitivity of serology

LiverLiver Lung cyst infectionLung cyst infection Other organ Other organ

involvementinvolvement

80-100%80-100%

55%55%

25-56%25-56%

USG is reliable non invasive USG is reliable non invasive method to diagnose hydatid cystmethod to diagnose hydatid cyst

CONCLUSIONCONCLUSION

Hydatid cyst should be Hydatid cyst should be considered in the differential considered in the differential diagnosis of soft tissue diagnosis of soft tissue swelling, especially in endemic swelling, especially in endemic areas.areas.