Chest wall hydatidosis as the unique location of the disease: Case report and review of the literature

The chest wall is a rare location of secondary hydatidosis, but secondary hydatidosis may occur from the rupture of a lung cyst, from a liver cyst invading the diaphragm into the pleural cavity, following previous thoracic surgery for hydatidosis, or by hematogenous spread. This report describes a case of chest wall hydatidosis, which was the primary disease site in the patient, who had no previous history or current disease (hydatidosis) at other sites. The cyst invaded and partially destroyed the 9th and 10th ribs and the 10th thoracic vertebra, and protruded outside the pleural cavity through the 9th intercostal space. Preoperative albendazole administration for 10 days, surgical resection of the disease through a posterolateral thoracotomy incision, and postoperative albendazole treatment resulted in a cure with no evidence of local recurrence or disease at other sites in four years of follow-up.Key Words: Chest wall echinococcosis, Echinococcosis, Hydatidosis, Pseudotumours of the chest wallHuman echinococcosis (hydatidosis) is a parasitic disease that was first identified by Hippocrates. The disease is endemic in many parts of the world (1,2). The majority of cases - approximately 90% - are caused by the parasite Echinococcus granulosus (1,3). Less common species of Echinococcus that cause human disease are: Echinococcus multilocularis or Echinococcus sibericensis caused by the foxes and rodents of Siberia, Alaska and Central Europe, which cause alveolar hydatid disease of the liver, Echinococcus vogeli, in South America and Echinococcus oligarthrus in South and Central America (1-5). In Greece, the disease is endemic with an annual incidence of hydatidosis, caused exclusively by E granulosus, of 10 cases per 100,000 inhabitants (unpublished data). In 85% of the cases E granulosus affects either the liver, lungs, or both, although any organ can be affected (5). Hydatidosis of the chest wall as the primary manifestation of the disease is rare (1,3,6). We report a case of chest wall hydatidosis and discuss the differential diagnosis of chest wall tumors and treatment.