Case Report

Primary Hydatid Disease of the Adductor Magnus. A Rare Location

by J Yasser*, Y Sebai, H Aitbenali, M Shimi

Department of Orthopedic Surgery and Traumatology, CHU Mohammed VI of Tangier, Morocco

*Corresponding author: Jaouad Yasser, Department of Orthopedic Surgery and Traumatology, CHU Mohammed VI of Tangier, Morocco

Received Date: 30 August 2023

Accepted Date: 20 September 2023

Published Date: 28 September 2023

Citation: Yasser J, Sebai Y, Aitbenali H, Shimi M (2023) Primary Hydatid Disease of the Adductor Magnus. A Rare Location. Ann Case Report. 8: 1467. https://doi.org/10.29011/2574-7754.101467

Abstract

Cystic echinococcosis is an infectious disease secondary to the contamination by Echinococcus granulosus. Muscle localization is very rare, and is characterized by atypical clinical presentation and the absence of pathognomonic signs, leading to diagnosis delays. MRI is the method of choice for diagnosis of soft tissue hydatid cysts, and surgery remains the main curative treatment. We report a case of hydatid cyst of the adductor magnus muscle in a 24- year-old young man, along with a literature review.

Keywords: Hydatid Cyst; Muscle;nEchinococcosis; Pericystectomy.

Introduction

Hydatid disease is a cosmopolitan illness, originating from the infection by Echinococcus granulosus [1]. Cystic echinococcosis affects mammals, including humans. The dog is like the final host, while humans are only intermediate hosts who become infected following contact with dogs or by ingesting contaminated food [2]. The hydatid cyst of the muscle remains a rare and exceptional entity even in endemic countries, the frequency of which does not exceed 5% [3,4]. We report a case of hydatid cyst localized in the adductor magnus muscle, and discuss the epidemiological and clinical profiles as well as the surgical treatment for this rare entity.

Case Presentation

The young patient is 24 years old, of rural origin, and with no significant pathological history. He consulted for a swelling of the inner side of the right thigh. The disease has begun 9 months before admission by the installation of a tumefaction on the medial face of the right thigh, which gradually increased in volume, without general signs. The clinical examination found a mass in the proximal third of the inner surface of the right thigh, measuring 15 cm*5 cm, adherent to the deep plane, of soft consistency, slightly painful on palpation, and without signs of vascular- nervous compression. MRI showed a cystic formation with a thin wall, slightly enhanced after the injection of contrast product. In its lower third, the loci were slightly smaller and more numerous with a higher signal in T1. This formation originated from the large adductor muscle and measured 15 cm in height by 7 cm*4 cm in transverse diameters. The adjacent muscular parenchyma was normal, and the mass remained distant from the superficial and deep femoral pedicle. This radiological description did not make it possible to evoke the diagnosis of a muscular hydatid cyst at the first intention. Surgery was then planned for both diagnosis and treatment purposes (Figures 1-3).

Figure 1: Contrast-enhanced magnetic resonance images of a cystic mass arising from the origin of the right adductor magnus.

The treatment was surgical with an internal approach. A pericystectomy was initiated. Given the difficulty of finding a cleavage plane, aspiration evacuation was performed associated with pericyst resection, while protecting the operative site with drapes soaked in hypertonic saline and hydrogen peroxide. The postoperative follow-up was simple. Anatomopathological examination of the surgical specimen confirmed muscular hydatidosis. After 9 months of follow up, no recurrence was detected.

Figure 2: postoperative view of the macroscopic aspect. The surgical specimen contained multiple small daughter cysts.