Hydatid cysts with unusual localizations: diagnostic and treatment dilemmas for surgeons

Although the liver and lung are by far the most common localizations for the larval cysts of Echinococcus granulosus in humans, the cysts may develop in other sites and there cause signs and symptoms that may be easily confused with those of other illnesses. In a retrospective study in Turkey, six male and 11 female cases of cystic echinococcosis, each with at least one cyst in an unusual site, were investigated. The patients, who had a mean age of 41.6 years, had cysts in the pancreas, intra-abdominal cavity, kidney, spleen, ovary, breast, mediastinum, chest wall, muscle and/or subcutaneous tissue. In terms of Gharbi's classification, 15 (75%) of the 20 cysts in these patients were type I and five (25%) were type II. Fourteen of the cases each had single cysts, two had multiple cysts, and one had an unknown number of cysts. All but one of the cases (who had a pancreatic cyst) were treated by total cystectomy. In areas where cystic echinococcosis is endemic, any patient presenting with a cystic mass, in any tissue or organ, should be considered a potential case of the disease and be carefully investigated by radio-imaging and/or ultrasonography.