Department of Diagnostic Radiology and Nuclear Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, 22110, Jordan.
Orthopedic Division, Special Surgery Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan.
BMC Pediatr. 2021 Aug 31;21(1):371. doi: 10.1186/s12887-021-02843-5.
Hydatid disease is an endemic disease in many countries of the world including the Middle East. It mainly affects the liver and lungs. Intramuscular hydatid disease is rarely reported in children. Such uncommon localization of hydatid cyst may pose difficulties in the clinical and radiological diagnosis; hence affecting patient's management and outcome even in endemic areas.
We herein describe intramuscular hydatid cysts in 2 different children. The first case is a 5-year-old boy who presented with a painless palpable lump over the right lumbar paraspinal region. His history was remarkable for sheep contact. His laboratory results revealed a mild increase in white blood cell (WBC) count and C-reactive protein. The lesion showed typical features of a hydatid cyst on ultrasound. Further imaging including ultrasound of the abdomen and CT of the chest, abdomen, and pelvis showed infestation of the liver and lung as well. The lesions were resected surgically without complications. The patient received Albendazole preoperatively and after surgery for 3 months. No evidence of recurrence was seen during follow-up. The second case is a 6-year-old girl who presented with an incidental palpable lump in her left thigh during her hospital admission for recurrent meningitis. Ultrasound and MRI imaging were performed demonstrating a unilocular cystic lesion in the left proximal rectus femoris muscle. A provisional diagnosis of hematoma vs. myxoma was given. Biopsy was performed and yielded blood products only. The lesion was resected surgically with a postoperative diagnosis of hydatid cyst. Blood tests performed afterward showed a positive titer for Echinococcus. The patient received Albendazole for 3 months. No evidence of recurrence was seen during follow-up.
Despite its rarity; skeletal muscle hydatid cyst should always be considered in the differential diagnosis of cystic muscle lesions in children in endemic areas even if imaging studies did not show any of the typical signs. This will improve patient outcome by preventing unnecessary cystic puncture which might lead to serious complications, such as anaphylaxis and local dissemination.
包虫病是世界上许多国家（包括中东地区）的地方病。它主要影响肝脏和肺部。儿童肌肉内包虫病很少见。这种不常见的包虫囊肿位置可能会在临床和影像学诊断中造成困难；因此，即使在流行地区也会影响患者的管理和结果。
我们在此描述了 2 例不同的儿童肌肉内包虫囊肿。第一例是一名 5 岁男孩，他的右侧腰背部出现无痛可触及的肿块。他的病史有与绵羊接触的情况。他的实验室结果显示白细胞 (WBC)计数和 C 反应蛋白轻度升高。超声显示病变具有包虫囊肿的典型特征。进一步的影像学检查，包括腹部超声和胸部、腹部和骨盆 CT 显示肝脏和肺部也有感染。病变通过手术切除，没有出现并发症。患者在术前和术后接受了阿苯达唑治疗 3 个月。在随访期间没有发现复发的证据。第二例是一名 6 岁女孩，在因复发性脑膜炎住院期间偶然发现左大腿有可触及的肿块。超声和 MRI 成像显示左股直肌近端有一个单房囊性病变。初步诊断为血肿与黏液瘤。进行了活检，但仅获得血液产物。手术切除病变，术后诊断为包虫囊肿。随后进行的血液检查显示包虫抗体滴度阳性。患者接受了 3 个月的阿苯达唑治疗。在随访期间没有发现复发的证据。
尽管罕见，但在流行地区，即使影像学检查没有显示任何典型征象，儿童囊性肌肉病变的鉴别诊断中也应始终考虑骨骼肌包虫囊肿。这将通过防止不必要的囊肿穿刺来改善患者的预后，因为这可能导致严重的并发症，如过敏反应和局部播散。
