Costal hydatidosis: management and outcome of five cases

Abstract

The objective of the study was to report our experience in the management of hydatid cyst of the rib. Between December 2001 and December 2009, five patients underwent surgery for costal echinococcosis, among 234 cases of thoracic hydatid cyst managed in our department. They were three males and two females, aged 19-42 years (mean = 32.2 years). Imaging investigations consisted of chest X-ray and computed tomography. All the patients underwent thoracotomy along the arch of the infected rib. Albendazole was administered postoperatively in all cases. The echinococcosis of the rib was primary in 3 cases, and secondary to thoracic localization in 2 cases. It was located on the right side in four patients, on the left one in one patient. The posterior arch was the site of infection in 3 cases, and the anterior arch in 2 cases. The cyst was intact in 4 cases, and the invasion of adjacent structures was found in one case. There were no concomitant hydatid lesions. The resection of the infected rib was total in 2 cases and partial in 3 cases. There was no postoperative mortality or complications. The follow-up ranged from 28 months to 8 years did not show any recurrence. Echinococcosis of the rib is very rare. To avoid complications and to allow the eradication of the disease, the combination of surgery and antihelmentic drugs remains the best therapeutic choice.

Cystic Hydatidosis of the Rib–Case Report and Review of the Literature

“…Sometimes mild, intermittent chronic chest pain, tumefaction of the area involved, a cutaneous fistula, or an intercostal neuralgia can be signs of the disease. 1,9) In our case, the pain occurred relatively recently and was attributed to a chest trauma.…”

“…[5][6][7][8] Bone hydatid cysts are very rare, between 0.5 and 2.5%, involving frequently the spine (44.2%), long bones (30%) and pelvis (16%). 9,10) Involvement of the ribs is extremely rare, less than 100 cases having been reported in the literature, 1) none of which from Romania according to our review of the databases available online.…”

“…Secondary hydatid cysts occur because of a spontaneous or intraoperative rupture of a pulmonary or mediastinalhydatid cyst. 1) Due to the fact that other sites of involvement have not been discovered, we assume that our patient has a primary hydatid cyst of the rib. The diagnosis of costal hydatid cysts is made by clinical, serological, imaging and surgical means.…”

“…12) The laboratory tests are often negative for osseous uncomplicated hydatidosis, while rupture of the cysts brings higher serological detection rates. 1,13) Taking these facts and the additional costs into consideration, we decided not to perform preoperative serological examinations.…”

“…Liver and lungs are the most commonly affected organs, bone hydatid cysts are rare,but less than 100 cases of costal hydatidosis have been reported in the literature. 1,2) We describe a recently diagnosed case of costal hydatidosis, the first one to be reported in Romania according to our review of the literature.…”