Журнал клинических случаев

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

Abstract

Slim Jarboui, Abdelwaheb Hlel, Alifa Daghfous and Andre Lepandru

Introduction: Hydatid cyst 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.
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 months history of pain and gradually growing mass located in the left supraclavicular region. Physical examination revealed a moderately hard, painful and erythamatous mass. The blood cell count was normal. Computed tomography demonstrated, a multilocular cystic lesion with thin borders, thin wall. The mass is binocular and extend 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 preoperatively 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. Histopathogical 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 follow-up.
Conclusion: The case illustrate that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when they occur in endemic areas.