Evaluation of imaging features of pelvic echinococcosis based on multimodal images.

BACKGROUND: Hydatid disease (HD) is a zoonotic parasitic disease caused by the larvae of Echinococcus, It is mainly prevalent in pastoral areas. Bone echinococcosis is rare, accounting for 0.5 to 4.0% of all echinococcosis. It is likely to miss the diagnosis and misdiagnose due to non-specific early symptoms and the clinical manifestations and imaging features. The clinical data of 15 patients with pelvic cystic echinococcosis were analyzed retrospectively, and the X-ray, CT, and MRI imaging features of the disease were discussed, which are reported below. METHODS: All 15 patients underwent CT scan evaluation. A total of 8 patients underwent coronal, sagittal, and three-dimensional reconstruction with 3-mm-slice thickness, and 4 patients underwent X-ray plain film examination. Five cases underwent MRI scan. Eight cases underwent MRI or CT enhanced scan. RESULTS: X-ray plain film is characterized by continuous cystic bone destruction, irregular low-density shadow when invading soft tissue, and sometimes calcification which can be seen on the wall or inside the cyst. The involved sacroiliac joint or hip joint may narrow or disappear. The involvement of pelvic cystic echinococcosis is relatively wide, and 80% of patients with pelvic cysts in this group had multiple lesions in the same period. Cystic expansive bone destruction was the most common. Pelvic CT revealed a lobulated hypodense lesion of varying size with internal septae, causing cortical thinning and destruction. Most of them had no periosteal reaction. The iliopsoas muscle is most easily invaded. Single cystic echinococcosis of pelvis showed intermediate or low signal intensity on T1-weighted images and hyperintensity on T2-weighted images in the involved bone and surrounding soft tissue on MRI, and the cyst wall showed linear low signal in T1WI, T2WI, and STIR sequences. The polycystic type is characterized by multiple cysts of varying signal intensity (daughter cysts) within a larger cyst is the typical MRI finding, forming "small vesicles" high signal daughter cysts. Osteosclerosis or calcification showed low signal in T1WI and T2WI. CONCLUSIONS: The results of this study suggest that the lesions of pelvic cystic echinococcosis are mostly cystic expansive and osteolytic bone destruction, which is easy to invade the surrounding soft tissue, often accompanied with calcification; among them, multiple cystic lesions are characteristic.

Ancient Ascaris DNA Sequences of Cytochrome B, Cytochrome C Oxidase Subunit 1, NADH Dehydrogenase Subunit 1, and Internal Transcribed Spacer 1 Genes from Korean Joseon Mummy Feces.

We analyzed Ascaris ancient DNA of cytochrome b, cytochrome c oxidase subunit 1, NADH dehydrogenase subunit 1, and internal transcribed spacer 1 genes extracted from the feces or precipitates of 15- to 18th-century Korean mummies. After multiple Ascaris genes in ancient samples were successfully amplified by polymerase chain reaction (PCR), consensus sequences could be determined by the alignment of the sequences of cloned PCR products. The obtained sequences of each gene were highly similar to those of Ascaris spp. reported thus far but were genetically distinct from Baylisascaris, Parascaris, and Toxascaris spp. The current report establishes that the genetic characteristics of the Ascaris spp. infecting pre-modern Korean societies were not uniform but were diverse to some degree.

[Bone hydatid cyst: a rare localization at the level of the hip bone]. / Un kyste hydatique osseux: une localisation rare au niveau de l'os iliaque.

Hydatid disease is a parasitic disease caused by the development in humans of the larval form of a tapeworm, namely a very small tænia called Echinococcus Granulosus. This anthropozoonosis is characterized by the presence of different types of anatomo-radiologic variants associated with various topographic and evolutionary aspects of the cysts. Bone hydatid disease is a rare condition, it accounts for only 0.9-2.5% of all locations. We report the case of a 9 year old child, who was admitted with febrile lameness and with a mass in the right iliac fossa, revealing a hydatid cyst at the level of the hip bone. Lesion assessment objectified a hydatid cyst of the hip bone with extension into adjacent soft tissues. An infected cyst was detected during surgery, hence the performance of a surgical excision of the cyst with drainage. Hydatic osteopathy is infiltrating, diffuse, slow and gradual, causing delays in diagnosis and compromising the quality of care.

Eradication of advanced pelvic hydatid bone disease after limb salvage surgery - 5-year follow-up: a case report.

INTRODUCTION: Echinococcosis is produced by the larval stage of Echinococcus granulosus; it is a parasitic disease which is seen rarely in humans and has adverse outcomes. We report a case of advanced pelvic hydatid bone disease with successful limb salvage surgery. Our patient had a 5-year follow-up without recurrence which is a rarity as per the literature. Early diagnosis and prompt medical therapy are necessary for effective management whereas delayed diagnosis is always fraught with the risk of recurrence and sepsis. CASE PRESENTATION: In 2009, a 30-year-old woman, native of Karachi (Sindhi ethnicity), presented at our clinic with history of a pathological fracture 11 years earlier. Her fracture was initially misdiagnosed and fixed. Subsequently she had persistent disease that progressed with time. Following this she underwent multiple surgeries and the diagnosis of hydatid disease was made but despite multiple debridements and medical therapy she was not cured and finally she was offered a hemipelvectomy (limb sacrifice). On presentation to our hospital she was counseled regarding options of hemipelvectomy versus a limb salvage form of modified internal hemipelvectomy and wide margin resection. She opted for limb salvage. She underwent internal hemipelvectomy with wide margin resection of soft tissue and proximal femur along with postoperative albendazole therapy. She was able to walk again after a very long period. Currently she is 5-years postreconstructive surgery. She is infection free and ambulant without support. CONCLUSIONS: Hydatid bone disease is a rare entity in our part of the world but a careful history and thorough look at the initial images of our patient would have led to the suspicion of pathologic fracture and subsequent early diagnosis of this difficult problem. A second important learning point in this case was the lack of early referral to a center where this difficult problem could have been handled effectively. This could have minimized the physical, mental and financial stress to the patient and her family.

[Hydatid cyst presenting with multiple recurrence and pelvic involvement: case report]. / Multiple rekürrensle seyreden pelvik tutulumlu hidatik kist: olgu sunumu.

Hydatid cyst disease is a parasitic infection which is caused by the metacestode form of Echinococcus granulosus and affects primarily the liver and lung. Bone involvement is found in 1% of patients afflicted with this disease. The spine is involved in about 50% of these cases. Herein, we report a 70 year old male case with pelvic and spinal hydatid cyst who was operated on eleven times.

Cystic echinococcosis of the pelvic bone with recurrences: a case report.

Hydatid cysts commonly affect the liver and the lung. However, they rarely involve bones with vertebral column. We hereby report a case of a female patient with cystic echinococcosis of the hip bone and ilium. She presented with a long history of frequent recurrences highlighting the dismal prognosis at this rare site. Resection of the hydatid cyst from the sacroiliac region was done with allograft and autograft (rib graft) with lumbosacroiliac fixation. Follow-up of the patient at 6 months showed no detectable abnormality on radiology and the patient was doing well.

Quantitative paleoparasitology applied to archaeological sediments

Three techniques to extract parasite remains from archaeological sediments were tested. The aim was to improve the sensibility of recommended paleoparasitological techniques applied in archaeological remains. Sediment collected from the pelvic girdle of a human body found in Cabo Vírgenes, Santa Cruz, Argentina, associated to a Spanish settlement founded in 1584 known as Nombre de Jesús, was used to search for parasites. Sediment close to the skull was used as control. The techniques recommended by Jones, Reinhard, and Dittmar and Teejen were used and compared with the modified technique presented here, developed to improve the sensibility to detect parasite remains. Positive results were obtained only with the modified technique, resulting in the finding of Trichuris trichiura eggs in the sediment.

A case of pelvic bone hydatidosis--diagnosis and treatment.

INTRODUCTION: Echinococcosis is a frequent helminthiasis in Bulgaria. Hydatid cysts commonly affect the liver and the lung. Echinococcosis rarely involves bones (0.5 to 2.5%) and vertebral column is affected in 50% of the cases. PATIENTS AND METHODS: We report a case of a 67-year-old female with echinococcosis of the pelvic bone clinically manifested by pain and swelling of the right iliac region and complicated by abscess of the surrounding soft tissue. The patient underwent surgery at the Department of Orthopedics and Traumatology, University hospital "St. George", Medical University, Plovdiv. Diagnosis was based on imaging findings, serologic and histological methods. Biopsy material was investigated by standard histological methods hematoxilin-eosin (H-E),PAS and hydrargyrum impregnation after Gommori, which presented both chitin and germinative membranes of the hydatid cyst. RESULTS: The patient underwent complete resection of the bone lesion along with the surrounding soft tissue. Purulent collection of 1200 ml was evacuated. A six months follow-up of the patient revealed no pathology of the cyst and other organs. She walked unaided. No echinococcosis recurrence was observed on control examinations. CONCLUSIONS: Hydatid bone disease is usually difficult to diagnose. Its treatment includes excision of bone lesion, curettage and oral therapy. It is not always possible to fully remove all the affected bone fragments especially when cysts are located in the femoral and pelvic bones. In the reported case the hydatid cyst was fully removed by resection of the right iliac ala and the patient's mobility was preserved.

Quantitative paleoparasitology applied to archaeological sediments.

Three techniques to extract parasite remains from archaeological sediments were tested. The aim was to improve the sensibility of recommended paleoparasitological techniques applied in archaeological remains. Sediment collected from the pelvic girdle of a human body found in Cabo Vírgenes, Santa Cruz, Argentina, associated to a Spanish settlement founded in 1584 known as Nombre de Jesús, was used to search for parasites. Sediment close to the skull was used as control. The techniques recommended by Jones, Reinhard, and Dittmar and Teejen were used and compared with the modified technique presented here, developed to improve the sensibility to detect parasite remains. Positive results were obtained only with the modified technique, resulting in the finding of Trichuris trichiura eggs in the sediment.

Hydatid disease of the pelvis and the femur. A case report.

We report a case of left-sided extended pelvic infestation of hydatid disease. The destruction of the hip joint, os pubis, larger parts of os ileum and the femoral head made pelvic resection and prosthetic replacement necessary. Recurrence of a hydatid cyst 5 years later in the left groin originating in the femur was treated with a second femoral resection and total hip replacement. Because of instability, the pelvic replacement also had to be changed to a custom-made CAD replacement. This surgical procedure was combined with chemotherapy by mebendazole. The need for radical resection in osseal hydatid disease is discussed.

Radiographic and computed tomographic findings in hydatid disease of bone.

Twenty-six patients with hydatid disease of bone were evaluated by means of radiography and conventional tomography. Fourteen patients underwent high resolution computed tomography (CT). In two patients with vertebral disease, magnetic resonance imaging (MRI) examination was also performed. Seventeen patients underwent surgery with histological examination in all. Based on the surgical data and gross examination of the specimen, the radiographic and CT findings have been reviewed to identify the most characteristic radiographic features and to assess the role of CT. Radiographic finding of hydatidosis are rarely typical in bone, and only in a few patients can CT contribute to the diagnosis. On the other hand, the local extension of the lesion both in bone and in soft tissues, which is essential in planning surgery, is always demonstrated well by CT.

[Osseous hydatidosis of the pelvic girdle. Contribution of computerized tomography and ultrasonics. Apropos of 3 cases]. / Hydatidose osseuse de la ceinture pelvienne. Apport de la tomodensitométrie et de l'échographie. A propos de 3 observations.

Three cases of bone hydatidosis of pelvis with invasion of soft tissues provided data on the effectiveness of CT scan and ultrasound imaging for diagnosis, evaluation of extension and follow up surveillance of this affection. Two of the three patients treated medically were followed up by review CT scan and ultrasound examinations. The two techniques were found to be effective for detecting recurrence and for surveillance of hydatid lesions of soft tissues during medical therapy.

[Hydatic cyst of the pelvis. Failure of treatment with flubendazole]. / Kyste hydatique du bassin. Echec du traitement par flubendazole.

In a 54 year old, algerian male we found a inoperable hydatid disease of the pelvis. A treatment by flubendazole 4 g/day is started on February 1982. The patient presents a neck of the femur fracture, on April 1982; on September 1982 he had a myocardial infarctus and a second one in February 1983. On March 1983 he had a new femur fracture. The biological data show no difference in hypereosinophilia and serological exploration. In this case the result is poor.