Visceral leishmaniasis complicated with hemophagocytic lymphohistiocytosis and resistant to amphotericin B: a case report.

INTRODUCTION: Hemophagocytic lymphohistiocytosis characterized by hemophagocytosis leading to uncontrolled inflammation; the most common etiology in secondary cases of hemophagocytic lymphohistiocytosis is viral infections, especially Epstein-Barr virus. Visceral leishmaniasis is a vectorborne protozoal disease caused by Leishmania donovani complex. It is common in tropical and subtropical regions, with 50,000-90,000 new cases annually. CASE PRESENTATION: A 15-month-old Arab female was admitted to our hospital with 15 days of fever and decreased weight. On clinical examination, she had a markedly enlarged liver and spleen that were palpable 4 cm and 6 cm below the costal margin, respectively. The peripheral blood smear showed hypochromic microcytic anemia, poikilocytosis, reactive lymphocytosis, and mild thrombocytopenia. Bone marrow aspiration did not show malignancy or any other pathological findings. The patient was put on antibiotic therapy without improvement. Repeated bone marrow aspiration showed erythrophagocytosis; intracellular small round organisms looked like the amastigote form of Leishmania (Donovan bodies) with no evidence of malignancies. Her lab values showed ferritin greater than 500 ug/L, pancytopenia, and hypertriglyceridemia. The patient was diagnosed with hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis. CONCLUSION: Hemophagocytic lymphohistiocytosis secondary to visceral leishmaniasis is an extensively rare phenomenon in the medical literature that causes challenges in diagnosis and management. Steroids should be used wisely to not cover the symptoms of infections or malignancy, and amphotericin B resistance should be kept in mind in unresponsive Leishmania cases.

Successful management strategy for giant primary hepatic rhabdomyosarcoma in 15-year-old male: a case report.

Primary hepatic rhabdomyosarcoma is an exceedingly rare type of sarcomas. A 15-year-old boy was admitted to the hospital with abdominal pain. Serial investigation showed a giant heterogeneous mass, with a diameter of 15 cm, located in the right lobe of the liver (segment 4a, 4b, 5, 6, 7, 8), with clear margins, non-homogeneous density in computerized tomography and the Positron Emission Tomography Scan Multi Slice revealed a peripherally slightly metabolically active hepatic mass (205 × 134 × 208 mm). Histopathological examination and the Immunohistochemical showed embryonal rhabdomyosarcoma. The management strategy involved multiple cycles of ifosfamide and doxorubicin and monitoring the tumor size, until the tumor size was suitable for the surgery. The management of hepatic rhabdomyosarcoma is a surgical challenge due to the late onset of symptoms, a limited number of reported cases, and poor prognosis. Surgical excision is the treatment of choice for primary hepatic rhabdomyosarcoma and combination between chemotherapy, surgery showed good results.

Breast cancer knowledge and practice of breast self-examination among Palestinian female, West Bank: A cross-sectional study.

Background: Worldwide, breast cancer (BC) is the most frequently discovered tumor in women. Breast self-examination (BSE) is a helpful screening method that gives women more control over their bodies by educating them about the structures of their breasts and assisting in the early detection of any developing breast abnormalities. The purpose of this research was to assess Palestinian girls' degree of BSE awareness and practice. Method: A self-administered questionnaire was used to gauge participants' knowledge about BC and associated topics. Through an online survey, all girls above the age of 20 are encouraged to take part in the study. Female university students at academic levels I, II, III, and IV in Palestine were also invited to participate in the study by way of an online survey. Results: The study included 467 female participants, with 69% of the individuals being single. The majority of females (68.7%) scored poorly on knowledge of BC disease (possible risk, methods of detection, methods of diagnosis, methods of treatment, signs and symptoms, information about mammography, and other knowledge questions), whereas only 31.7% scored well. Conclusion: BC, which is thought to be the most common malignant development among them and the second leading cause of cancer mortality, is one of the issues that women in the West Bank face. Screening methods are crucial for the early detection of BC and for lowering disease-related morbidity and mortality. It has been advised that starting at age 20, every woman should take the BSE.

A late diagnosis of primary intestinal lymphangiectasia in a Syrian girl.

Primary intestinal lymphangiectasia is a rare disease that affects children and young adults, causing mainly gastrointestinal disorders that lead to edema and immunologic abnormalities. The majority of patients typically present bilateral lower limb edema, along with pericarditis, pleural effusion, or chylous ascites. The goal of the treatment is to restrict the consumption of long-chain fats and administer a formula that includes protein and medium-chain triglycerides. Here, we report 11-year-old Syrian girl presented to the hospital with 2 years history of diarrhea and generalized edema. Furthermore, investigation showed ascites and pleural effusion. The disease was detected by several biopsies from duodenum that showed dilation of the lymph vessels within the lamina propria without any evidence for inflammation. She was managed by modifying her diet and albumin transfusion, which caused significant improvement in the child's condition.

Successful management of late stage of acute compartment syndrome after 72 h snake bite in 8-year-old female. A case report.

One of the most serious complications of snakebite is compartment syndrome (CS), Signs of CS include paresthesia in the distal part and pain that is out of proportion to the severity of the injury, Management involves improving the general condition, and fasciotomy has been found to be effective. An 8-year-old girl was referred to the internal emergency department in our hospital 72 h after a snake bite. She was unconscious, in poor general condition, and had a high fever. Edema was present throughout the right lower limb, extending to the abdomen, with signs of cellular necrosis (blackening with bubbles) on the right foot. The diagnosis of CS was made, and the patient underwent fasciotomy after improving the general condition. Although snake bites are rare, surgeons should be concerned about life-threatening and limb-threatening complications. CS can be effectively treated with fasciotomy. Additionally, it is important to emphasize the significance of daily dressing and regular follow-up for achieving the best results.

A rare co-occurrence of renal cell carcinoma, bilateral adrenal metastasis and inferior vena cava thrombus: A case report.

INTRODUCTION: The incidence of ipsilateral adrenal metastasis from RCC varies between 1.1 and 10 %, on the other hand, the presence of bilateral adrenal metastasis from solitary RCC is extremely rare, with less than 20 reported cases in the literature. CASE PRESENTATION: A 68-year-old man presented to the clinic with hematuria. Further investigations, contrast CT, showed mass at the right kidney and adrenal gland, a mass on the left adrenal gland and inferior cava thrombosis measuring 3*6 cm. The patient underwent, first, right nephrectomy and adrenalectomy with thrombectomy and IVC plasty. Microscopic examination showed clear cell renal cell carcinoma, while adrenal tissue showed metastatic renal cell carcinoma. The patient was followed up from the oncological, endocrinological and cardiac point of view. After 6 months he underwent left adrenalectomy. Subsequent follow-up showed body free of metastases. CLINICAL DISCUSSION: The co-occurrence of renal cell carcinoma, bilateral adrenal metastasis, and inferior vena cava thrombus is a very rare phenomenon in the literature. Most patients with adrenal metastasis are asymptomatic, and the adrenal function is typically preserved even when malignancy affects bilateral adrenal glands. In addition, patients with adrenal ipsilateral metastases typically have primary renal tumors with poor prognosis. CONCLUSION: The Diagnosis and management are a surgical challenge. Contrast-enhanced CT scan is the preferred imaging modality for renal cell carcinoma. The surgical intervention is mandatory if it can increase survival rate.

Successful management of an amputated hand at the distal row level of carpal bones in low-resources country: A case report.

INTRODUCTION: Hand replantation (HR) surgery is a delicate and complex procedure that requires a multidisciplinary team (MT) and specialized equipment, as well as factors such as ischemia time and injury mechanism that can impact the procedure's potential complications and success rate. We present the first case of successful management within a low-resources setting of an amputated hand in Syria. PRESENTATION OF CASE: A 20-year-old male presented to the emergency department with an amputated left hand at the distal row of carpal bones (CB) with sharp edges. We first managed the condition by stopping the bleeding and washing the hand with saline. The MT performed a ten-hour surgery to reattach the hand using external fixation and vascular, orthopedic, and neurosurgical procedures. The patient was discharged seven days after surgery and had regular follow-ups for two years and seven months, which showed normal sensory evaluation and mild numbness in the ulnar side of the dorsal side of the palm. DISCUSSION: HR surgery is challenging and requires an MT and appropriate equipment. Also, amputated hand management requires a specialized center, which was absent in our settings. Hence, the outcome of the surgery was excellent, considering the traditional and old-fashioned techniques followed to establish such an operation in a low-resources country. CONCLUSION: Precise preoperative, intraoperative, and postoperative procedures, besides long-term follow-up, are crucial to ensure HR surgery success and effectiveness, in addition to the patient's recovery.

How do university students perceive the educational transition in the COVID-19 era: A cross-sectional study from 15 Arab countries.

Background and Aims: The viral agent of the novel coronavirus disease 2019 (COVID-19) continues to spread worldwide, leading to a global pandemic. this may negatively affect students' mental health who have to maintain their learning efforts. Therefore, we aimed to assess students' perceptions of the online learning programs designed for university students in Arab countries during the COVID-19 pandemic. Methods: This cross-sectional study was conducted on university students using a self-administered online questionnaire in 15 Arab countries, including 6779 participants. The actual sample size was calculated using the EpiInfo program calculator. The validated, piloted questionnaire assessed the effectiveness of internet-based distance learning applications used in these countries during the pandemic. The SPSS version 22 was used. Results: Among the 6779 participants, 26.2% believed that their teachers diversify learning methods, 22.0% thought that their teachers were able to treat the weakness the students have, and 30.7% agreed that their teachers efficiently communicate with them through COVID-19 internet-based learning process. Around 33% of students participated in lectures effectively, 47.4% submitted their homework within accepted deadlines, and 28.6% thought that their colleagues did not cheat during exams and homework. Around 31.3% of students believed that online-based learning had a role in directing them towards research, and 29.9% and 28.9%, respectively, believed that online learning had a role in developing analytical thinking and synthesis skills. Participants reported many suggestions to enhance the process of internet-based distance learning in the future. Conclusion: Our study suggests that online-based distance learning in Arab countries still needs more improvement as students still are more inclined toward face-to-face teaching. However, exploring the factors that influence students' perceptions of e-learning is vital for improving the quality of online-based distance learning. We recommend exploring the perceptions of educators regarding their experience towards online-based distance learning during COVID-19 lockdown.

Incidental diagnosis of pseudomyxoma peritonei by laparoscopy: a rare case from Syria.

Pseudomyxoma peritonei (PMP) is a rare malignancy of the abdomen, which is usually described as a gelatinous peritoneal fluid. A 33-year-old man came to the ER complaining of recurring abdominal pain with abdominal distention for the past 3 months. Abdominal ultrasound revealed moderate amount of turbulent ascitic fluid with septations, in addition to a mass with irregular margins consisting of liquid and cysts. Abdomen and pelvis computed tomography scan showed free abdominal fluid. A decision was made for abdominal diagnostic laparoscopy with biopsies from the peritoneum, mesenteries and the gelatinous fluid. We could not investigate all the abdominal cavities and appendix due to the presence of severe adhesions and tuberculosis suspension. The pathology report indicated PMP. The patient was referred to an oncologist for chemotherapy consultation. The diagnosis can be challenging, as the symptoms and signs vary from patient to another; most cases may be asymptomatic and discovered incidentally during laparoscopy.

Renal primitive neuroectodermal tumor. The first case series from Syria.

Primitive neuroectodermal tumor (PNET) mainly arises from soft tissues of the extremities such as humerus, femur, C tibia. It rarely arises from kidney; less than 200 cases have been reported in the literature. The clinical presentation and radiography findings are not specific. Here we first report two cases of renal primitive neuroectodermal tumor in Syria. the first patient was 26-year-old- female that presented to urology clinic complaining of right flank pain. Ultrasonography of the abdomen showed a large mixed heterogeneous mass in the right kidney with no hemorrhage or calcification and MSCT of abdomen and pelvis demonstrate a mixed well-demarcated heterogeneous mass measuring (74*117) mm in the right kidney right radical nephrectomy was performed. The second patient 19-year-old-male presented with left flank pain. Ultrasonography of the abdomen showed mixed large mass involving the left kidney, with unmarked border. The CT of the abdomen and pelvis demonstrating a (30*110*90) mm left renal mass and periaortic lymphadenopathy measuring (45*28) mm. The patient underwent Left radical nephrectomy with periaortic lymphadenectomy dissection. The final diagnosis for both cases was Renal PNET based on microscopic and immunohistochemistry examination. In patient with suspected renal mass in the radiographic images, the diagnosis of renal primitive neuroectodermal tumor should be kept in the mind despite its rarity. The final diagnosis is done by histopathological study in association with immunohistochemical examination.

Prevalence of obesity and its association with fast-food consumption and physical activity: A cross-sectional study and review of medical students' obesity rate.

Background: obesity is a widespread condition with more than 400 million obese-person all over the world. It is expected of medical students to follow healthy habits as they are more familiar with the risks of obesity. In contrast, many studies showed that medical students eat fast food, spend much time on smart devices, and do not play sports. Aim: This study is the first cross-sectional study conducted to evaluate the prevalence of obesity and some daily habits carried out by medical students of Aleppo University. Method: The data of our cross-sectional study were collected between the 13th-20th of March 2021 through an online google form posted on different social media platforms. The questionnaire was divided into two main sections: firstly, participants' demographics (including age, gender, and academic year). In addition, medical students were asked to document their weight and height to estimate their Body Mass Index (BMI). The second section contained questions concerning daily habits including, the number of meals, breakfast, physical exercises, and fast food consumption. Chi-square and Fisher tests were performed by IBM SPSS statistics to analyze our data. Results: Our sample size was 514 medical students of Aleppo University. (22.1%) of them were overweight or obese (BMI> 25). Most (73.5%) eat fast food once a week or more. In addition, (39%) have three meals or more daily, and (55.7%) have two meals every day. Regarding physical activity, (76.7%) do not play sports, and (62.1%) use buses to come to the college.Stress eaters were associated significantly(p-value<0.05) with being overweight, and (70.8%) of them had a history of being overweight (p-value<0.05). Contrary to females, we found that most males were not stressed-eaters (p-value<0.05).

An inguinal hernia revealing an advanced stage gastric cancer in a young patient: A case report.

Introduction: Gastric cancer (GC) is the fifth most common cancer and the fourth leading cause of death. It is much more common in advanced age and it is rare among the youngest patients (under 45 years of age). Case presentation: we report an unusual presentation of advanced gastric adenocarcinoma in 39-year-old man, who presented to our hospital with inguinal hernia without obvious gastrointestinal symptoms. He had strong family history of cancer, heavy smoking habit and weight loss. The intra-operative procedure identified a cyanotic separate spermatocele which was confirmed by the urologist. During investigation we found multiple liver metastasis in abdominal CT and advanced gastric adenocarcinoma from gastric biopsy and metastasis in spermatic cord sample and peritoneum sample of poorly differentiated adenocarcinoma. Conclusion: Although stomach adenocarcinoma is extremely rare in young patient but it should be kept in mind of physicians as a possible diagnosis if there are many risk factors.

Evaluation of memantine's efficacy and safety in the treatment of children with autism spectrum disorder: A systematic review and meta-analysis.

BACKGROUND: The United States Food and Drug Administration has approved drugs that address only autism-related symptoms rather than the underlying impairments. N-Methyl-D-Aspartate  receptor antagonists have recently emerged as a promising treatment option for a variety of neurologic and developmental problems, including autism. AIMS: To review (systematically), for the first time, the medical literature that explores the safety in and efficacy of memantine in autism. METHODS AND PROCEDURES: A comprehensive electronic search for relevant randomized controlled trials was conducted in four databases. Using RevMan software, we extracted and pooled data as a risk ratio (RR) or normalized mean differences in an inverse variance strategy. RESULTS: This systematic review and meta-analysis includes five trials. There was no difference in enhancing social responsiveness when compared to placebo, though memantine lowered the likelihood of anxiety (RR = 0.25; 95% Confidence interval: [0.07; 0.87], p = 0.03). However, memantine aggravated impulsive behaviors. Additionally, in another trial that compared memantine added to risperidone versus risperidone added to placebo, memantine was found to be effective and safe. CONCLUSION: Memantine showed safety in reducing acute symptoms of anxiety and other symptoms encountered in pediatric patients with autism spectrum disorders. However, memantine does not improve the core symptoms of autism. Nevertheless, further long-term trials are needed to explore its potential efficacy.

Late infection of a breast prosthesis with staphylococcus aureus in a healthy woman: a case report.

Infection following breast augmentation is a rare event with an incidence rate of 1-2.5%. Late onset infections following breast augmentation are very rare. Herein, we present a case of breast implant infection in a 29-year-old female patient who underwent a bilateral augmentation mammoplasty with a silicone gel prosthesis. After 8 uneventful post-operative years, she presented with right-sided signs of breast infection. She initially treated medically but without improvement. Then, she underwent surgical washout and debridement with removal of the bilateral breast implants. Culture demonstrated Staphylococcus aureus. The clinical history and management of this unusual case are described. Because most of the infections occurs in the first few weeks after augmentation mammoplasty, there is a paucity of data about late onset infections. The most common cultured organism in the early infection is S. aureus.

Normal values of antistreptolysin O for adults ages 30 to 70 in Syria: A cross sectional study.

BACKGROUND: Group A Streptococcus is a very common pathogen which infects a large scale of people around the world causing many symptoms such as scarlet fever, sinusitis, and pneumonia. Most strains of group A and many other strains of group C and G Streptococcus bacteria secreted antigen called Streptolysin O. Anti-streptolysin O (ASO) is an antibody produced against streptolysin O that rises after 1 week of infection by streptococcus bacteria, which helps in diagnosing this type of infectious diseases. We conducted a Cross-Sectional study to determine the Upper Limit of Normal (ULN) for healthy adult in Aleppo, Syria. MATERIALS AND METHODS: A sero-epidemiological cross-sectional study was conducted from September to October in 2019. ASO titers were determined on 267 healthy patients' companions who visited Aleppo University Hospital. Geometric mean titer and Upper Limit of Normal of ASO were calculated according to sex, age and residency. Upper Limit of Normal were defined as the 80th percentile. RESULTS: Out of 267 participants; 126 (45.7%) were males and 150 (54.3) were females. The Upper Limit of Normal for total participants was 210.8 IU/ml. There was no significant difference (P-value > 0.05) among males (204.6 IU/ml) and females (225.8 IU/ml). In contrast to sex, there was a significant difference (P-value < 0.05) according to age groups, where the highest Upper Limit of Normal was in the 30-39 age group (256.0 IU/ml). CONCLUSION: ASO test is a common, easy, cheap method, so getting enough data about it is very important in the developing countries (such as Syria). In Aleppo, Syria we found that the ULN was higher than ULN from other studies. There was no significant difference according to sex and residency. On the other hand, there was significant difference according to age groups.

Syrian medical, dental and pharmaceutical publication in the last decade: A bibliometric analysis.

BACKGROUND: Scientific research has an essential role in building up the basics of public health and clinical care. As a developing country, Syria has a limited contribution to scientific research. Besides, the current Syrian crisis has inflicted severe damage to the infrastructure of the country, which, in turn, negatively affected the scientific sphere. This study examines the scientific publishing in Syria from 2011 until 2020. It aims to define the real and deep reasons for the slow-down in publication to get over them, push Syria to keep track of the latest updates, and take its place in scientific research. METHODS: We conducted a bibliometric analysis of articles published in (PubMed and Scopus) Databases from 1/1/2011 until 26/12/2020, using the following search terms (("Syrian Arab Republic") OR (Syria) OR (Syrian)) limiting the search to (Affiliation) fields. RESULTS: Syrian medical, dental and pharmaceutical institutions published 1403 papers from 2011 until 2020. There were only 55 papers in 2011, and a peak with 180 papers in 2018. Besides, publications in the last 4 years were 1.135 times more than publications in the last 6 years. CONCLUSION: We noticed a peak in quantity of Syrian medical, dental and pharmaceutical publications in the last decade. Accordingly, we recommend enhancing research skills, paying more attention to the quality of researches, and holding research workshops and Evidence Based conferences to enhance the scientific endeavor.

A rare case of polyorchidism in a 40-year-old man. A case report.

INTRODUCTION: and importance Polyorchidism is defined as the presence of three testes or more. Approximately, there are about 200 cases of polyorchidism in the medical literature. In the past, surgical treatment was done but now with imaging studies, less aggressive approach is recommended.Here we present a case of 40-year-old man who was diagnosed incidentally with polyorchidism in the right hemiscrotum which is quite unusual in this age. CASE PRESENTATION: A 40-year-old man presented to the emergency department with a swelling and pain in the left hemiscrotum. In palpation, we noticed a scrotal mass in the right hemiscrotum. His parents had first noticed a scrotal mass when he was two years old and was incorrectly diagnosed as hydrocele by an unauthorized practitioner.In the left hemiscrotum, Doppler confirmed acute epididymitis diagnosis that was treated conservatively with antibiotics and NSAIDs. In the right hemiscrotum, MRI showed that the lump had separate epididymis and shared a common vas deferens with the right testis, which confirmed the diagnosis of supernumerary testis and the patient underwent a follow-up ultrasound after a month and after six months of his presentation. DISCUSSION: Triorchidism is the most common type of polyorchidism. Polyorchidism is diagnosed incidentally hence it is asymptomatic. There are many types of Polyorchidism and tow classification have been described. When the patient is asymptomatic the concentrative treatment is recommended. CONCLUSION: Polyorchidism is a rare congenital anomaly in the genitourinary tract. It is diagnosed incidentally. Ultrasound or MRI are used to diagnose polyorchidism cases.

Cholecystocutaneous fistula incidence, Etiology, Clinical Manifestations, Diagnosis and treatment. A literature review.

Cholecystocutaneous Fistula (CCF) is a type of external biliary fistula, which connects the gallbladder with the skin. Thilesus first described this phenomenon in 1670. There is usually a history of calculi in the gallbladder or neglected gallbladder disease. The incidence of CCF is rare, most patients are elderly females with the mean age of 72.8 years old. They usually present with chronic calculus cholecystitis or a history of a previous surgical intervention. US, CT, MRI, MRCP and (CT or X-ray) fistulogram are used to confirm the diagnosis. CT was more significant than US in identifying the track of the fistula and the fluid that runs throw it. CCF patients presented with systemic symptoms (fever, nausea and vomiting) or local symptoms. RUQ region is the most common site of external opening. Open cholecystectomy with excision of the fistulous tract is considered an acceptable option for treatment and it is curative in most cases. However, laparoscopic approach can be another option with experience surgeons.

Bilateral anophthalmia and intrahepatic biliary atresia, two unusual components of Fraser syndrome: a case report.

BACKGROUND: Fraser syndrome or "cryptophthalmos syndrome" is a rare autosomal recessive disease. It is characterized by a group of congenital malformations such as: crytophthalmos, syndactyly, abnormal genitalia, and malformations of the nose, ears, and larynx. Although cryptophthalmos is considered as a main feature of Fraser syndrome, its absence does not exclude the diagnosis. Clinical diagnosis can be made by Thomas Criteria. Here we present the first documented case of Fraser Syndrome in Aleppo, Syria that is characterized by bilateral anophthalmia and intrahepatic biliary atresia. CASE PRESENTATION: During pregnancy, several ultrasound scans revealed hyperechoic lungs, ascites, and unremarkable right kidney at the 19th-week visit; bilateral syndactyly on both hands and feet at the 32nd-week visit. On the 39th week of gestation, the stillborn was delivered by cesarean section due to cephalopelvic disproportion. Gross examination showed bilateral anophthalmia, bilateral syndactyly on hands and feet, low set ears, and ambiguous genitalia. Microscopic examination of the lung, spleen, liver, ovary, and kidneys revealed abnormalities in these organs. CONCLUSION: The diagnosis of Fraser syndrome can be made prenatally and postnatally; prenatally by ultrasound at 18 weeks of gestation and postnatally by clinical examination using Thomas criteria. Moreover, intrahepatic biliary atresia was not described previously with Fraser syndrome; this recommends a more detailed pathologic study for Fraser syndrome cases.

Uncommon musculoskeletal femoral hydatid cyst disturbs a female for a year: Case report.

"Hydatid cyst" which also known as cystic Echinococcosis is a parasitic infestation caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most sites to occur. Incidence in muscles is exceptionally rare. We report a case of a 36-year-old female presented with an uncomfortable mass in the upper medial of her right thigh without any presence of other symptoms. She lived in a rural area in Manbij, which is an endemic area of hydatid cysts in Syria. She was a shepherdess; therefore she had direct contact with sheep and dogs. Ultrasound examination showed a cyst located between adductor longus muscle and gracilis muscle closed to the deep femoral artery. The patient was treated with pharmaceutical therapy for a week before cystectomy, which was done under general anesthesia. The cyst was dissected between the fibers of adductor longus muscle from the lateral side and fibers of the gracilis muscle from the medial side. The cyst with all its layers was resected. Musculoskeletal Echinococcosis is a rare disease, because of intramuscular growth of cysts is restricted by muscle's contractility, the muscles are undesirable habitat for Echinococcus granulosus and because of the hepatic barrier role. Many cysts are revealed by complications such as nerve compressions, infections simulating an acute abscess or a malignant tumor. Hydatid cyst present as mass of soft tissue, particularly in endemic areas, as a result of contaminated water. MRI considered the best technique in the diagnosis.