Primary hydatid cysts of the left thigh

Hydatid cyst is a zoonotic larval infection caused by Echinococcus granulosus, which demonstrates a global distribution with a higher prevalence in livestock farming regions in the Mediterranean, the Middle East, India, and Oceania [1]. Humans are incidental intermediate hosts, while animals such as dogs, wolves, and foxes serve as definitive hosts [2]. Hydatid cysts arise most commonly in the liver (60%) and the lungs (30%), while other sites include the spleen, kidneys, bones, muscles, and brain. Primary muscular hydatidosis is an uncommon clinical entity, with incidence ranging from 1% to 5%, and the most frequently affected locations are the roots of the limbs and the trunk [3–5].
Herein, we report a case of an 82-year-old female living in a rural setting, exhibiting a painless mass on her left thigh persisting for 3 years. Additionally, she reported experiencing a mild fever, which commenced 5 days prior to her hospital admission. She had a medical history notable for atrial fibrillation, arterial hypertension, and appendicectomy. Her physical examination yielded no significant findings, except for the palpable mass. An ultrasound scan and magnetic resonance imagibg (MRI) scan, initially conducted at a different institution, prompted concerns regarding the existence of a hydatid cyst. Subsequently, this was confirmed following fine-needle aspiration and a positive serology test for Echinococcus granulosus. The patient underwent a PAIR (puncture, aspiration, injection, reaspiration) procedure twice, coupled with a 6-month course of albendazole. However, she was subsequently referred to our hospital due to multiple recurrences. Upon re-evaluation, laboratory tests indicated an elevated white blood cell count and increased C-reactive protein levels, with no other abnormal findings. A follow-up MRI scan revealed multiloculated cystic lesions in the medial compartment of her left thigh with high signal intensity on T2-weighted images (Figure 1). No other organs were affected. The diagnosis of a secondary thigh infection, along with signs of septicaemia, in the context of recurrent primary muscular hydatid cyst, was established, and the patient was treated with antibiotics. Subsequently, she underwent another PAIR session, which yielded suboptimal results, without adequate drainage of the cyst (Figure 2). The multidisciplinary team advised surgical removal of the hydatid cyst located in her left thigh, a procedure that was executed alongside...


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