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The multifaceted musculoskeletal hydatid disease

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Abstract

Musculoskeletal hydatid disease is rare and can be located anywhere but most commonly the bone and muscles of the spine, pelvis, then the lower limbs. Imaging is essential for its diagnosis, performing the pre-therapeutic assessment, guiding possible percutaneous treatments, and providing post-therapeutic follow-up. Musculoskeletal hydatidosis can take several forms that may suggest other infections and tumors or pseudotumors. MRI and CT are superior for its diagnosis but ultrasound and radiography remain the most accessible examinations in developing countries where this parasitosis is endemic. In this review, we provide an overview of this disease and describe its different imaging patterns in soft tissue and bone involvement that should be sought to support the diagnosis.

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Drs Ammar, and Riahi had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of their analysis.

References

  1. World Health Organization. Fact sheet on echinococcosis (updated May 2019). Weekly Epidemiological Record. 2019;94:574–9. Available from: https://apps.who.int/iris/handle/10665/330007. Accessed 1 July 2023

  2. Stojkovic M, Weber TF, Junghanss T. Clinical management of cystic echinococcosis: state of the art and perspectives. Curr Opin Infect Dis. 2018;31. Available from: https://journals.lww.com/co-infectiousdiseases/Fulltext/2018/10000/Clinical_management_of_cystic_echinococcosis_.3.aspx.

  3. Arkun RM Berna Dirim. Musculoskeletal hydatid disease. Semin Musculoskelet Radiol. 2011;15:527–40. Available from: http://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0031-1293498.

  4. Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev. 2004;17:107–35.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mushtaque M, Mir MF, Malik AA, Arif SH, Khanday SA, Dar RA. Atypical localizations of hydatid disease: experience from a single institute. Niger J Surg. 2012;18:2–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Agudelo Higuita NI, Brunetti E, McCloskey C. Cystic Echinococcosis. J Clin Microbiol. 2016;54:518–23.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Khadeeja Abees Hmood Al-Khalidi, Hiba Riyadh Al-Abodi, Hayder Kamil Jabbar, Baheeja A. Hmood. Echinococcus granulosus. In: Fethi Derbel, Meriem Braiki, editors. Overview on Echinococcosis. Rijeka: IntechOpen; 2020;Ch. 4. https://doi.org/10.5772/intechopen.90708.

  8. Song XH, Ding LW, Wen H. Bone hydatid disease. Postgrad Med J. 2007;83:536–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Tropica. 2010;114:1–16. Available from: https://www.sciencedirect.com/science/article/pii/S0001706X09003581.

  10. Akhan O, Gumus B, Akinci D, Karcaaltincaba M, Ozmen M. Diagnosis and percutaneous treatment of soft-tissue hydatid cysts. Cardiovasc Intervent Radiol. 2007;30:419–25.

    Article  PubMed  Google Scholar 

  11. García-Alvarez F, Torcal J, Salinas JC, Navarro A, García-Alvarez I, Navarro-Zorraquino M, et al. Musculoskeletal hydatid disease: a report of 13 cases. Acta Orthop Scand. 2002;73:227–31.

    Article  PubMed  Google Scholar 

  12. Bygott JM, Chiodini PL. Praziquantel: Neglected drug? Ineffective treatment? Or therapeutic choice in cystic hydatid disease? Acta Tropica. 2009;111:95–101. Available from: https://www.sciencedirect.com/science/article/pii/S0001706X09000783.

  13. Akhan O, Yildiz O, Unal E, Yildiz AE, Ciftci TT, Akinci D. Case report: imaging-guided percutaneous catheterization and microwave ablation of a bone hydatid cyst with soft-tissue component. Am J Trop Med Hyg. 2022;107:632–5. Available from: https://www.ajtmh.org/view/journals/tpmd/107/3/article-p632.xml.

  14. Papavasiliou K, Panagiotidou S, Kakoulidis P, Bintoudi A, Arvaniti K, Tsiridis E. Cystic Echinococcosis of the ilium treated with curettage and microwave thermoablation followed by bone cement installation: a novel treatment technique for a rare disease. Lyons MK, editor. Case Rep Orthop. 2021;2021:5533183. https://doi.org/10.1155/2021/5533183.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wa Z-C, Du T, Hu H-T, Lu M-D. Microwave ablation combining surgery for the treatment of multiorgan cystic echinococcosis: A case report. Parasitol Int. 2020;74:101921. Available from: https://www.sciencedirect.com/science/article/pii/S1383576918303842.

  16. Brunetti E, Filice C. Radiofrequency thermal ablation of echinococcal liver cysts. The Lancet. 2001;358:1464. https://doi.org/10.1016/S0140-6736(01)06518-7.

    Article  CAS  Google Scholar 

  17. Vasilevska V, Zafirovski G, Kirjas N, Janevska V, Samardziski M, Kostadinova-Kunovska S, et al. Imaging diagnosis of musculoskeletal hydatid disease. Prilozi. 2007;28:199–209.

    CAS  PubMed  Google Scholar 

  18. Ladeb MF, Riahi H, Mechri M, Chelli Bouaziz M, Trabelsi S, Rammeh S. Imaging of Spinal Hydatidosis. In: Ladeb MF, Peh WCG, editors. Imaging of spinal infection. Cham: Springer International Publishing; 2021;237–50. Available from: https://doi.org/10.1007/978-3-030-70459-9_13.

  19. Polat P, Kantarci M, Alper F, Suma S, Koruyucu MB, Okur A. Hydatid disease from head to toe. RadioGraphics. 2003;23:475–94. https://doi.org/10.1148/rg.232025704.

    Article  PubMed  Google Scholar 

  20. Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications. RadioGraphics. 2000;20:795–817. https://doi.org/10.1148/radiographics.20.3.g00ma06795.

    Article  CAS  PubMed  Google Scholar 

  21. Neumayr A, Tamarozzi F, Goblirsch S, Blum J, Brunetti E. Spinal cystic Echinococcosis – a systematic analysis and review of the literature: Part 1. Epidemiology and Anatomy. PLOS Negl Trop Dis. 2013;7:e2450. https://doi.org/10.1371/journal.pntd.0002450.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tekin R, Avci A, Tekin RC, Gem M, Cevik R. Hydatid cysts in muscles: clinical manifestations, diagnosis, and management of this atypical presentation. Rev Soc Bras Med Trop. 2015;48:594–8.

    Article  PubMed  Google Scholar 

  23. Alouini Mekki R, Mhiri Souei M, Allani M, Bahri M, Arifa N, Jemni Gharbi H, et al. Kyste hydatique des tissus mous : apport de l’IRM (À propos de trois observations). J de Radiologie. 2005;86:421–5. Available from: https://www.sciencedirect.com/science/article/pii/S0221036305813769

  24. Kayaalp C, Dirican A, Aydin C. Primary subcutaneous hydatid cysts: A review of 22 cases. Int J Surg. 2011;9:117–21. Available from: https://www.sciencedirect.com/science/article/pii/S1743919110004632

  25. Bayram M, Sirikci A. Hydatic cyst located intermuscular area of the forearm: MR imaging findings. Euro J Radiol. 2000;36:130–2. https://doi.org/10.1016/S0720-048X(00)00188-1.

    Article  CAS  Google Scholar 

  26. Cankorkmaz L, Ozturk H, Koyluoglu G, Atalar MH, Arslan MS. Intermuscular hydatid cyst in a 4-year-old child: a case report. J Pediatr Surg. 2007;42:1946–8. https://doi.org/10.1016/j.jpedsurg.2007.07.051.

    Article  PubMed  Google Scholar 

  27. Ramos Pascua L, Santos Sanchez JA, Samper Wamba JD, Alvarez Castro A, Rodriguez Altonaga J. Atypical image findings in a primary subcutaneous hydatid cyst in the gluteal area. Radiography. 2017;23:e65–7. Available from: https://www.sciencedirect.com/science/article/pii/S1078817417300494.

  28. Cepparo J-M, Wiart E, Senneville E, Cotten A. Chapitre 11 - Infections rachidiennes. In: Cotten A, editor. Imagerie Musculosquelettique : Pathologies Générales (Deuxième Édition). Paris: Elsevier Masson; 2013;307–35. Available from: https://www.sciencedirect.com/science/article/pii/B9782294719240000115.

  29. Damarey B, Petyt G, Senneville E, Morillon D, Cotten A. Chapitre 12 - Infections ostéoarticulaires extra-rachidiennes. In: Cotten A, editor. Imagerie Musculosquelettique : Pathologies Générales (Deuxième Édition). Paris: Elsevier Masson; 2013;337–82. Available from: https://www.sciencedirect.com/science/article/pii/B9782294719240000127.

  30. Khadraoui M-B, Arifa-Achour N, Mhiri-Souei M, Elouni F, Jemni H, Mrad-Dali K, et al. Apport de l’IRM dans le diagnostic d’une hydatidose humérale pseudo-tumorale. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur. 2005;91:341–5. Available from: https://www.sciencedirect.com/science/article/pii/S0035104005843326.

  31. Ammar A, Souissi B, Khrifech M, Maalej MA, Abid H, Haddar S, et al. Imagerie du kyste hydatique: du plus commun à l’exceptionnel (à propos de 216 cas). Journées Françaises de Radiologie (JFR) 2014, Paris, France; Available from: https://lamediatheque.radiologie.fr/mediatheque/media.aspx?mediaId=4473&channel=3277.

  32. Simsek O, Ciledag N. Musculoskeletal hydatid disease: The serpent sign. Radiology. 2021;301:280–1. https://doi.org/10.1148/radiol.2021210956.

    Article  PubMed  Google Scholar 

  33. Comert RB, Aydingoz U, Ucaner A, Arikan M. Water-lily sign on MR imaging of primary intramuscular hydatidosis of sartorius muscle. Skelet Radiol. 2003;32:420–3. https://doi.org/10.1007/s00256-003-0661-x.

    Article  CAS  Google Scholar 

  34. Gharbi HA, Hassine W, Brauner MW, Dupuch K. Ultrasound examination of the hydatic liver. Radiology. 1981;139:459–63. https://doi.org/10.1148/radiology.139.2.7220891.

    Article  CAS  PubMed  Google Scholar 

  35. Working Group WI. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Tropica. 2003;85:253–61. Available from: https://www.sciencedirect.com/science/article/pii/S0001706X02002231.

  36. von Sinner WN. New diagnostic signs in hydatid disease; radiography, ultrasound, CT and MRI correlated to pathology. Euro J Radiol. 1991;12:150–9. Available from: https://www.sciencedirect.com/science/article/pii/0720048X9190119G.

  37. Jerbi Omezzine S, Abid F, Mnif H, Hafsa C, Thabet I, Abderrazek A, et al. Kyste hydatique primitif de la cuisse. Une localisation rare. Revue de Chirurgie Orthopédique et Traumatologique. 2010;96:105–8. Available from: https://www.sciencedirect.com/science/article/pii/S1877051709004328.

  38. Yildirim F, Turan A, Guven S, Ceylan A. An extrahepatic hydatid cyst with the fat-fluid level. BJR Case Rep. 2022;8:20210059.

    PubMed  Google Scholar 

  39. Tarhan N, Tuncay I, Barutcu O, Demirors H, Agildere A. Unusual presentation of an infected primary hydatid cyst of biceps femoris muscle. Skelet Radiol. 2002;31:608–11. https://doi.org/10.1007/s00256-002-0524-x.

    Article  CAS  Google Scholar 

  40. Arslan M, Gulek B, Ogur HU, Adamhasan F. Primary hydatid cyst in the posterior thigh, and its percutaneous treatment. Skelet Radiol. 2018;47:1437–42. https://doi.org/10.1007/s00256-018-2910-z.

    Article  Google Scholar 

  41. Chelli Bouaziz M, Jelassi H, Chaabane S, Ladeb MF, Ben M-M. Imaging of chest wall infections. Skeletal Radiol. 2009;38:1127–35.

    Article  PubMed  Google Scholar 

  42. Cohen M, Moraux A, Cotten A. Chapitre 16 - Pseudo-tumeurs des tissus mous. In: Cotten A, editor. Imagerie Musculosquelettique : Pathologies Générales (Deuxième Édition). Paris: Elsevier Masson; 2013;521–7. Available from: https://www.sciencedirect.com/science/article/pii/B9782294719240000164.

  43. Rimondi E, Rossi G, Bartalena T, Ciminari R, Alberghini M, Ruggieri P, et al. Percutaneous CT-guided biopsy of the musculoskeletal system: Results of 2027 cases. Euro J Radiol. 2011;77:34–42. Available from: https://www.sciencedirect.com/science/article/pii/S0720048X10003876.

  44. M.F. Ladeb, M. Chelli Bouaziz, M. Chakroun, C. Loussaief. Atteintes parasitaires de l’appareil locomoteur. Radiologie et Imagerie Médicale : Musculosquelettique - Neurologique - Maxillofaciale. 2013; Available from: http://www.sciencedirect.com/science/article/pii/S1879-8551(13)60685-5.

  45. Charrada-Ben-Farhat L, Saïd W, Bouslama K, Oueslati S, Dridi L, Rezgui-Marhoul L, et al. Hydatidose vertébromédullaire : intérêt de l’imagerie. Médecine et Maladies Infectieuses. 2006;36:58–61. Available from: https://www.sciencedirect.com/science/article/pii/S0399077X05002313.

  46. Neumayr A, Tamarozzi F, Goblirsch S, Blum J, Brunetti E. Spinal cystic echinococcosis – a systematic analysis and review of the literature: Part 2. Treatment, follow-up and outcome. PLOS Negl Trop Dis. 2013;7:e2458. https://doi.org/10.1371/journal.pntd.0002458.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Hôpital Raymond-Poincaré - APHP - DMU Smart Imaging - GH Université Paris-Saclay (U 1179 UVSQ/Paris-Saclay), 104 Boulevard Raymond Poincaré, 92380, Garches, France

    Amine Ammar, Nadia Venturelli, Valentin Renault, Benjamen Dray, Dominique Safa & Robert-Yves Carlier

  2. Department of Radiology, MT Kassab Institute of Orthopaedics - Faculty of Medicine of Tunis - Tunis-El Manar University, Ksar Saïd – Manouba, 2010, Tunis, Tunisia

    Hend Riahi, Mohamed Chaabouni & Mouna Chelli Bouaziz

  3. Department of Pathology, MT Kassab Institute of Orthopaedics - Faculty of Medicine of Tunis - Tunis-El Manar University, Ksar Saïd - Manouba, 2010, Tunis, Tunisia

    Leila Abid

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  1. Amine Ammar
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Key points

• Hydatidosis of bone and soft tissues is rare and can be located anywhere but most commonly the bone and muscles of the spine, pelvis, then the lower limbs.

• MRI is the key examination for the diagnosis of bone hydatidosis showing bone infiltration by multiple vesicles.

• Suggestive signs on radiographs are general preservation of bone shape, extension to neighboring bones without harm to the joint, and extension to soft tissues.

• Characteristic features in soft tissue are a multivesicular appearance, hydatid sand, triple layer cyst wall on ultrasound and hypointensity on MRI, and membrane detachment.

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Ammar, A., Riahi, H., Chaabouni, M. et al. The multifaceted musculoskeletal hydatid disease. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04644-0

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