|Year : 2014 | Volume
| Issue : 1 | Page : 28-30
Hydatid disease involving pectoralis minor muscle alone
Bhupinder Singla, Inderjit Chawla, Karnail Singh, Mandeep Singh, Jalaj Rathi, Sorabh Gupta
Department of General Surgery, Government Medical College, Rajindra Hospital Patiala, Patiala, Punjab, India
|Date of Acceptance||13-Nov-2013|
|Date of Web Publication||16-Jun-2014|
Department of General Surgery, Government Medical College, Rajindra Hospital Patiala, Punjab-147 001
Source of Support: None, Conflict of Interest: None
Hydatid cysts are rarely found in muscles. Reports have shown the presence of hydatid cysts in the pectoralis major muscle alone or together with the pectoralis minor muscle. Herein, we present a rare case of a hydatid cyst found in the pectoralis minor muscle alone without the involvement of the pectoralis major or any other muscle or organ.
Keywords: Hydatid cyst, pectoralis minor, echinococcosis
|How to cite this article:|
Singla B, Chawla I, Singh K, Singh M, Rathi J, Gupta S. Hydatid disease involving pectoralis minor muscle alone. Niger J Surg Sci 2014;24:28-30
| Introduction|| |
The liver and lungs are the organs most frequently affected by hydatid cysts. Although any organ in the body may be involved, it is uncommon to locate a hydatid cyst in a muscle.  We encountered a case where a hydatid cyst was found in a pectoralis minor muscle alone.
| Case Report|| |
A 22-year-old male patient arrived at a surgery OPD complaining of swelling over the left side of his chest [Figure 1]. He had been experiencing the swelling for the past year and claimed it was gradually increasing in size. No history of trauma was found. No history of similar swelling in any other part of the body was reported. He was a student and resided in an area non-endemic for hydatid disease. A clinical examination revealed that the swelling was occurring deep in the pectoralis major muscle. A chest x-ray and abdomen ultrasound returned normal results. No other palpable swelling was present in the body. A computed tomography (CT) scan of the chest was performed and showed multiple hydatid-type cysts in the pectoralis minor muscle [Figure 2] a, b. The patient was operated-on and a hydatid cyst was excised and shelled out from the pectoralis minor muscle after retracting the pectoralis major muscle, as shown in [Figure 3] a, b and c. The cavity was irrigated with a scolicidal agent. On gross examination, the specimen showed a hydatid cyst wall and daughter cysts [Figure 4]. The patient was started on albendazole tablets, and improved with no recurrence or any other complaint at 2 year follow-up [Figure 5].
|Figure 2: CT chest showing hydatid cyst in pectoralis minor muscle (2a: axial view, 2b: coronal view)|
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|Figure 3: (a, b) Hydatid cyst in pectoralis minor muscle after retracting pectoralis major muscle (c) Complete removal of the hydatid cysts from pectoralis minor muscle|
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| Discussion|| |
Echinococcosis, often referred to as hydatid disease is a parasitic disease of tapeworms in the genus Echinococcus. There are three different forms of echinococcosis found in humans, each of which is caused by the larval stages of different species. The most common form found in humans is cystic echinococcosis, which is caused by Echinococcus granulosus 
All disease-causing species of Echinococcus are transmitted to intermediate hosts via the ingestion of eggs and are transmitted to definitive hosts by means of eating infected, cyst-containing organs. Humans are accidental intermediate hosts that become infected by handling soil, dirt or animal hair that contains eggs. 
The liver and lungs are the two organs most commonly affected by hydatid cysts involved in 75% and 10% cases, respectively.  Any organ of the body can be involved, but hydatid cysts in muscles are rare. One report from Turkey described a hydatid cyst in the adductor muscle group.  Abdel-Khaliq described pectoralis major muscle involvement.  Pouche et al., showed hydatid cysts in rectus and back muscles.  Hydatid cysts in muscles are similar to hydatid cysts elsewhere in the body. They have thin walls, resembling the pericyst, with small internal daughter cysts indicated by a ultrasound (US) scan. ,,
The management of hydatid liver or lung disease is well-known. The principles for treating hydatid disease at unusual sites such as the musculoskeletal region are essentially the same: complete surgical excision of all cysts and sterilization of the cavity with scolicidal agents such as hydrogen peroxide, hypertonic saline, formaldehyde, alcohol, ether and cetrimide to prevent recurrence.  Mebendazole and albendazole are used as prophylaxis and after surgery to prevent recurrence.
All musculoskeletal swellings should be investigated with radiological tests to rule out or confirm the diagnosis in both endemic and non-endemic areas, as population mobility and migration lead to an increased prevalence of this disease in previously non-affected regions.  As discussed earlier, the presence of hydatid cysts in different muscles has been reported. However, the isolated presence of a hydatid cyst in a pectoralis minor muscle has not been reported until now. Our case report on pectoralis minor muscle involvement is therefore rare and unusual.
| References|| |
|1.||Berger SA, Marr JS. Human Parasitic Diseases Sourcebook. Sudbury: Jones and Bartlett Publishers; 2006. |
|2.||Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004;17:107-35. |
|3.||Canda MS, Guray M, Canda T, Astarcioglu H. The pathology of echinococcosis and the current echinococcosis problem in Western Turkey. Turk J Med Sci 2003;33:369-74. |
|4.||Kamhawi S. A retrospective study of human cystic echinococcosis in Jordan. Ann Trop Med Parasitol 1995;89:409-14. |
|5.||Milanese A, Camana GP, Carbone P. Echinococcus cyst in the pelvic cavity: Presentation of case. Minerva Urol Nephrol 1991;43:301-3. |
|6.||Abdel-Khaliq RA, Othman Y. Hydatid cyst of pectoralis major muscle. Case report and note on surgical management of muscle echinococcosis. Acta Chir Scand 1986;152:469-71. |
|7.||Cangiotti L, Muiesan P, Begni A, de Cesare V, Pouchè A, Giulini SM, et al. Unusual localization of hydatid disease: An 18-year experience. G Chir 1994;15:83-6. |
|8.||Lewall DB, Mocorkell SJ. Hepatic echinococcal cyst: Sonographic appearance and classification. Radiol 1985;155:773-5. |
|9.||Durr-e-Sabih, Sabih Z, Khan AN. "Congealed water lily" sign: A new sonographic sign of liver hydatid cyst. J Clin Ultrasound 1996;24:297-303. |
|10.||Lupetin AR, Dash N. Intrahepatic rupture of hydatid cyst: MR findings. AJR Am J Roentgenol 1988;151:491-2. |
|11.||Safioleas M, Misiakos EP, Dosios T, Manti C, Lambrou P, Skalkeas G. Surgical treatment for lung hydatid disease. World J Surg 1999;23:1181-5. |
|12.||Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Working Group on Echinococcosis. Bull World Health Organ 1996;74:231-42. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]