Unusual Location of Primary Hydatid Cyst: Soft Tissue Mass in the Supraclavicular Region of the Neck

Abstract

Cystic hydatid disease is a zoonosis caused by Echinococcus granulosus. It may affect any organ and tissue in the body, in particular the liver and Lung. Musculoskeletal or soft tissue hydatidosis accounts for about 0,5%–5% of all echinococcal infections in endemic areas and is almost secondary to the hepatic or pulmonary disease (Karaman et al., 2011; Dirican et al., 2008; Kouskos et al., 2007). Case Presentation. We report an unusual case of primary subcutaneous hydatidosis in the left supraclavicular region of the neck. A 53-year-old female patient was admitted with three-month history of pain and gradually growing mass located in the left supraclavicular region. Physical examination revealed a moderately hard, painful, and erythematous mass. The blood cell count was normal. Computed tomography demonstrated, a multilocular cystic lesion with thin borders and thin wall. The mass is binocular and extends to the scapula. CT showed no involvement of the lung. From these signs, the patient was diagnosed as having abscess (bacterial infection or tuberculosis). The diagnosis of Echinococcus granulosus infection was made per operatively after visualization of the cyst wall and the daughter cysts. Following irrigation of cystic cavity with hypertonic saline solution, the cyst wall was excised along with a portion of surrounding tissue. Histopathological examination of the specimen confirmed the hydatid origin. Hemagglutination tests for Echinococcus and ELISA were negative. Ultrasound of the abdomen was normal. The patient received albendazole (400 mg/day) for 8 weeks postoperatively. No sign of recurrence could be detected by physical examination and imaging (CT) at 4-month followup. Conclusion. The case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when it occurs in endemic areas.

Primary hydatid cyst of anterior thigh - an unusual location

“…Lung and liver are the two most commonly affected organs. Intramuscular hydatid cyst can be either primary or occur secondarily due to spread from other involved organs [1]. Primary intramuscular hydatid cyst is extremely rare because contractility of muscle and presence of lactic acid often inhibit their growth [2,3].…”

A Fatal and Rare Case of Hydatid Cyst in the Pouch of Douglas

“…4,5 Most hydatid cysts present with abdominal pain, nausea, and jaundice, considering that liver is the most common site (59-75%). 6 A few patients have presented with a slow-growing occipitocervical mass, a painful mass growing in the left lateral side of the neck, and left gluteal pain and limb weakness, for a cyst in the cervical region, 7 the supraclavicular region, 8 and in the left deep gluteal muscle, 9 respectively. These are the rare presentations of hydatid cyst that have been reported.…”

Tricky diagnosis of a primary gluteal hydatid cyst

“…Preoperative diagnosis of gluteal hydatid disease is challenging especially in non‐endemic countries. Computed tomography and magnetic resonance imaging are the diagnostic modalities of choice as they can show the cyst characteristics as well as the involvement of the adjacent tissues with high sensitivity and specificity 5 …”