Skip to main content

Advertisement

SpringerLink
Log in

Popliteal Echinococcosis: A Long Journey from the Liver

  • Case Report
  • Published:
Acta Parasitologica Aims and scope Submit manuscript

Abstract

Introduction

Intra-abdominal and pelvic seeding of hepatic cystic echinococcosis to various organs is a known feature of the disease. Dissemination into distal extremities is uncommon and in this report, we present a case of disseminated cystic echinococcosis extending toward the right popliteal fossa.

Case Presentation

A 68-year-old male presented with swelling in the right upper leg and discomfort in the right popliteal region. Work-up revealed various cystic mass lesions of different sizes within the liver, intra-abdominal cavity, right inguinal region, right femoral region, and right popliteal fossa. Diagnosis of hepatic cystic echinococcosis was made and the patient was started on medical therapy.

Discussion

Hepatic cysts can be easily observed with ultrasonography and the WHO-Informal Working Group on Echinococcosis (WHO-IWGE) classification system is commonly used to further classify cysts. The work-up of the disseminated disease involves further radiological modalities such as computerized tomography and magnetic resonance imaging. Management includes medical therapy, percutaneous drainage, or surgery depending on hepatic cyst localization and the presence of dissemination.

Conclusion

Extrahepatic dissemination of cystic echinococcosis is commonly encountered in endemic areas. Rarely, hepatic cysts can spread beyond the abdomen towards the distal extremities. Therefore, cystic echinococcosis should be included in the differential diagnosis in endemic areas where patients present with cystic masses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nourbakhsh A, Vannemreddy P, Minagar A, Toledo EG, Palacios E, Nanda A (2010) Hydatid disease of the central nervous system: a review of literature with an emphasis on Latin American countries. Neurol Res 32(3):245–251. https://doi.org/10.1179/016164110X12644252260673

    Article  PubMed  Google Scholar 

  2. Addy F, Alakonya A, Wamae N, Magambo J, Mbae C, Mulinge E, Zeyhle E, Wassermann M, Kern P, Romig T (2012) Prevalence and diversity of cystic echinococcosis in livestock in Maasailand, Kenya. Parasitol Res 111(6):2289–2294. https://doi.org/10.1007/s00436-012-3082-8

    Article  PubMed  Google Scholar 

  3. Tamarozzi F, Akhan O, Cretu CM et al (2018) Prevalence of abdominal cystic echinococcosis in rural Bulgaria, Romania, and Turkey: a cross-sectional, ultrasound-based, population study from the HERACLES project. Lancet Infect Dis 18(7):769–778. https://doi.org/10.1016/S1473-3099(18)30221-4

    Article  PubMed  Google Scholar 

  4. Pavletic CF, Larrieu E, Guarnera EA et al (2017) Cystic echinococcosis in South America: a call for action. Rev Panam Salud Publica 41:e42. https://doi.org/10.26633/RPSP.2017.42

    Article  PubMed  PubMed Central  Google Scholar 

  5. Romig T, Ebi D, Wassermann M (2015) Taxonomy and molecular epidemiology of Echinococcus granulosus sensu lato. Vet Parasitol 213(3–4):76–84. https://doi.org/10.1016/j.vetpar.2015.07.035

    Article  CAS  PubMed  Google Scholar 

  6. Casulli A, Massolo A, Saarma U et al (2022) Species and genotypes belonging to Echinococcus granulosus sensu lato complex causing human cystic echinococcosis in Europe (2000–2021): a systematic review. Parasit Vectors 15(1):109. https://doi.org/10.1186/s13071-022-05197-8

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sabouni F, Ferdosian F, Mamishi S, Nejat F, Monnajemzadeh M, Rezaei N (2010) Multiple organ involvement with hydatid cysts. Iran J Parasitol 5(2):65–70

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO-IWGE (2010) Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 114(1):1–16. https://doi.org/10.1016/j.actatropica.2009.11.001

    Article  PubMed  Google Scholar 

  9. Uriarte C, Pomares N, Martin M, Conde A, Alonso N, Bueno MG (1991) Splenic hydatidosis. Am J Trop Med Hyg 44(4):420–423. https://doi.org/10.4269/ajtmh.1991.44.420

    Article  CAS  PubMed  Google Scholar 

  10. Fenane H, el Maidi M, Bouchikh M et al (2015) Hydatidose péricardique [Pericardial hydatidosis]. Pan Afr Med J 20:375. https://doi.org/10.11604/pamj.2015.20.375.3124

    Article  PubMed  PubMed Central  Google Scholar 

  11. Arteaga CM, García-Ripoll JRT, Ruíz SA et al (2006) Hidatidosis renal [Renal hydatidosis]. Arch Esp Urol 59:739–742

    Google Scholar 

  12. Tapia EO, Vidal TA, Antonio PL (2012) Hidatidosis cerebral: aspectos clínicos e imagenológicos. Reporte de 4 casos [Brain hydatidosis: report of four cases]. Rev Med Chil 140:358–363

    Article  Google Scholar 

  13. Hakeem A, Shafi H, Gojwari TA, Rasool S, Ahmad M (2009) Primary mediastinal hydatid disease leading to popliteal artery hydatid cyst embolization. Ann Saudi Med 29(5):407–409. https://doi.org/10.4103/0256-4947.55174

    Article  PubMed  PubMed Central  Google Scholar 

  14. Battyany I, Andrea L, Nagy KK (2011) Subcutaneous hydatid cyst in the popliteal fossa at the site of a previous wasp sting. Diagn Interv Radiol 17(2):163–165. https://doi.org/10.4261/1305-3825.DIR.2933-09.1

    Article  PubMed  Google Scholar 

  15. Aletras HA (1967) Embolism of the popliteal artery by a ruptured hydatid cyst of the heart. Scand J Thorac Cardiovasc Surg 1(3):188–190. https://doi.org/10.3109/14017436709131866

    Article  CAS  PubMed  Google Scholar 

  16. Ibáñez Esquembre V, Solá R, Pelayo M (1990) Embolización hidatídica múltiple: isquemia aguda de miembro inferior derecho. A propósito de un caso [Multiple hydatid embolism: acute ischemia of the right lower limb. Apropos of a case]. Angiologia 42(3):89–94

    PubMed  Google Scholar 

  17. Al-Hakkak SMM, Al-Faham FSM, Al-Awwady AN (2019) Acute limb ischemia caused by ruptured cardiac hydatid cyst - a case report. Int J Surg Case Rep 55:18–22. https://doi.org/10.1016/j.ijscr.2018.12.005

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hèla BJ, Abir B, Majdi G, Aiman D, Iheb S, Nizar E, Sayda M, Imed F (2015) Interventricular septum hydatid cyst presenting with acute lower limb ischemia: a case report. Libyan J Med 10:28634. https://doi.org/10.3402/ljm.v10.28634

    Article  PubMed  Google Scholar 

  19. Ye J, Zhang Q, Xuan Y, Chen S, Ma L, Zhang Y, Zheng H (2016) Factors associated with Echinococcosis-induced perioperative anaphylactic shock. Korean J Parasitol 54(6):769–775. https://doi.org/10.3347/kjp.2016.54.6.769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E (2008) Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 79(3):301–311

    Article  PubMed  Google Scholar 

  21. Agudelo Higuita NI, Brunetti E, McCloskey C (2016) Cystic Echinococcosis. J Clin Microbiol 54(3):518–523. https://doi.org/10.1128/JCM.02420-15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Gavara CG, Ibáñez TB, López-Andújar R et al (2015) Review of the treatment of liver hydatid cysts. World J Gastroenterol 21:124–131. https://doi.org/10.3748/wjg.v21.i1.124

    Article  Google Scholar 

  23. Velasco-Tirado V, Alonso-Sardón M, Lopez-Bernus A, Romero-Alegría Á, Burguillo FJ, Muro A, Carpio-Pérez A, Muñoz Bellido JL, Pardo-Lledias J, Cordero M, Belhassen-García M (2018) Medical treatment of cystic echinococcosis: systematic review and meta-analysis. BMC Infect Dis 18(1):306. https://doi.org/10.1186/s12879-018-3201-y

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ran B, Shao Y, Guo Y et al (2015) Surgical treatment of hepatic cystic echinococcosis in patients co-infected with HIV/AIDS. J Helminthol 90(1):125–128

    Article  PubMed  Google Scholar 

  25. Keskin F, Erdi F, Kalkan E, Karatas Y (2013) Recurrence of primary spinal cyst hydatid in a HIV (+) patient: a case report. J Neurol Sci 30:455–460

    Google Scholar 

  26. Sharifi Y, Sadjjadi SM, Nikoupour Dailami H, Jafari SH, Anbardar MH, Khosravi MB (2021) Cystic Echinococcosis/hydatid cyst coinfection with HIV: a report from Shiraz, Iran. Can J Gastroenterol Hepatol 2021:8844104. https://doi.org/10.1155/2021/8844104

    Article  PubMed  PubMed Central  Google Scholar 

  27. Eckert J (1996) Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO informal working group on Echinococcosis. Bull World Health Organ 74(3):231–242

    Google Scholar 

  28. Chai JY, Jung BK, Hong SJ (2021) Albendazole and Mebendazole as anti-parasitic and anti-cancer agents: an update. Korean J Parasitol 59(3):189–225. https://doi.org/10.3347/kjp.2021.59.3.189

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Tamarozzi F, Horton J, Muhtarov M, Ramharter M, Siles-Lucas M, Gruener B, Vuitton DA, Bresson-Hadni S, Manciulli T, Brunetti E (2020) A case for adoption of continuous albendazole treatment regimen for human echinococcal infections. PLoS Negl Trop Dis 14(9):e0008566. https://doi.org/10.1371/journal.pntd.0008566

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Not available.

Author information

Authors and Affiliations

  1. Department of General Surgery, Istanbul University Cerrahpasa - Cerrahpasa School of Medicine, Cerrahpasa Mah., Kocamustafapaşa Cad., No: 34, Fatih, Istanbul, Turkey

    Ergin Erginöz, Sefa Ergün, Emre Tunç & Salih Pekmezci

Authors
  1. Ergin Erginöz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sefa Ergün
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emre Tunç
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Salih Pekmezci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ergin Erginöz.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare.

Ethical approval

Written informed consent was obtained from the patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Erginöz, E., Ergün, S., Tunç, E. et al. Popliteal Echinococcosis: A Long Journey from the Liver. Acta Parasit. 68, 463–467 (2023). https://doi.org/10.1007/s11686-023-00669-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11686-023-00669-y

Keywords

Search

Navigation