Journal of Postgraduate Medicine
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CASE REPORTS
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Year : 1992  |  Volume : 38  |  Issue : 4  |  Page : 194-5,197  

Hydatid cyst of the tibia.

C Madiwale, A Shenoy, A Joshi, I Vora, SS Hemmadi, PB Bhosale 
 Dept. of Pathology, Seth GS Medical College, Parel, Bombay, Maharashtra.

Correspondence Address:
C Madiwale
Dept. of Pathology, Seth GS Medical College, Parel, Bombay, Maharashtra.

Abstract

A case of hydatid cyst of the tibia, which manifested as a pathologic fracture is being reported. Pain and swelling of left lower limb with inability to bear the weight were the main features. Tender swelling was also noted at the upper and middle third of tibia. Open biopsy revealed the hydatid cyst wall and scolices of Echinococcus granulosus. Albendazole treatment was followed by curettage and bone grafting.



How to cite this article:
Madiwale C, Shenoy A, Joshi A, Vora I, Hemmadi S S, Bhosale P B. Hydatid cyst of the tibia. J Postgrad Med 1992;38:194-5,197


How to cite this URL:
Madiwale C, Shenoy A, Joshi A, Vora I, Hemmadi S S, Bhosale P B. Hydatid cyst of the tibia. J Postgrad Med [serial online] 1992 [cited 2019 Jun 25 ];38:194-5,197
Available from: http://www.jpgmonline.com/text.asp?1992/38/4/194/673


Full Text




  ::   IntroductionTop


Skeletal hydatid disease is rare and often presents as a clinical and radiologic diagnostic problem. We present a case of hydatid cyst of the tibia.


  ::   Case reportTop


A 40-year-old male farmer presented with a three month history of pain and swelling in the left lower limb. The patient was unable to bear weight on this limb. A tender swelling was noted at the upper and middle third of the tibia with abnormal mobility at this level. Routine haemogram was normal. Radiologic examination revealed multiple osteolytic lesions with no reactive sclerosis [Figure:1]. A pathologic fracture was also noted. A clinical diagnosis of an adamantinoma was considered and an open biospy was performed. On histopathology, it revealed the characteristic trilamellar hydatid cyst wall and scolices of Echinococcus granulosus scattered amidst fragments of bone and marrow [Figure:2]. There was no inflammatory reaction or fibrosis. An ultrasound examination was performed later, which revealed hydatid cysts in the liver and lung. The patient was treated with albendazole and a curettage with bone grafting was-performed three months later. Curettage yielded numerous intact and partly fragmented, translucent cystic structures which showed features of hydatid cyst on histology. The patient was then lost to follow-up.


  ::   DiscussionTop


Skeletal involvement occurs only in 1% of all cases of hydatid disease[1]. The lesion though usually secondary to hepatic or pulmonary hydatidosis may on occasion occur as a primary disease[2]. Cases have been reported in the vertebrae, femur, tibia and pelvis[3],[4],[5].

Intraosseous lesions usually start at the epiphyses and may be either polycxstic or less often in the form of a solitary hydatid cyst[6]. The polycystic type occurs because owing to bone rigidity the cyst becomes unable to expand and fragments with diffuse spread of the daughter cysts and scolices along the bone canals. In both types, pressure absorption of the bone with resultant thinning and fracture and extension through the periosteum and soft tissues leading to sinus formation are known to occur[7].

Hydatid disease of the bone is often asymptomatic for a long duration and is usually detected only after a sudden fracture, secondary infection or neurovascular lesion caused by compression[4],[5],[6],[7],[8]. However, a definite pre-operative diagnosis without histologic examination is often difficult; as there are no pathognomonic signs, radiologic findings may be confused with those of other lesions and serologic tests are of limited value[7].

The unusual feature in this case was the presenting features involving skeletal system and not the liver and lung, even though hydatid cysts were present in the latter organs. This case also emphasises the importance of considering osseous hydatidosis in the differential diagnosis of destructive bone lesions.


  ::   AcknowledgmentTop


We wish to thank Dr PM Pai, Dean, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, for permission to publish this case report.

References

1 Alldred AJ, Nisbet NW, Hydatid of bone in Australasia. J Bone and Joint Surg 1964; 46-13:260-267
2Patond KR, Srivastava SK, Kumar N. Musculoskeletal Hydatidosis. Indian Pract 1991; 54:299-302.
3Voutsinas S, Sayakos J, Srnymis P. Echinococcus infestation complicating total hip replacement. J Bone Joint Surg 1987; 69-B:1456-1458.
4Karray S, Fowles JV, Zouari O, Slimne N, Kassab MT, Rosset P. Vertebral hydatidosis and paraplegia. J Bone Joint Surg 1990; 72-13:84-88.
5Knudsen C, Marks R, Learmonth GM. Orthopaedic hydatid disease (Abstract). J Bone Joint Surg 1988; 70-13:504.
6Pintilie DC, Panoza GH, Hatmann D, Faher M. Echinococcus of the humerus. Treatment by resection and bone drafting: a case report. J Bone Joint Surg 1966; 48-A:957-961.
7Morris DL. Musculoskeletal hydatid disease. In: Coombs R, Fitzgerald RH Jr, editors. Infections in the Orthopaedic Patients. London: Butterworth and Co Ltd; 1989, pp 314-322.
8Duran H, Ferrandez L, Gomez-Castresana F. Osseous hydatidosis. J Bone Joint Surg 1978; 60-A 685-690.

 
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