These are interesting cases. Parasites will go anywhere!

http://www.ncbi.nlm.nih.gov/pubmed/3601139?ordinalpos=1&itool=EntrezSyste...

 
Minerva Med. 1987 Jul 15;78(13):921-31

Bone echinococcosis

[Article in Italian]

Di Gesù G, Massaro M, Picone A, La Bianca A, Fiasconaro G.

Hydatidosis of the bone is a rare form of human echinococcosis. Due to the clinical, diagnostic, therapeutic and prognostic problems involved, the costal and occipital locations are of particular interest. Both are rare and differ from visceral locations in that they are always "primary" and have the capacity to destroy the bone matrix and infiltrate the adjacent tissues. The course of the disease is particularly slow and without specific signs and symptoms so that it can look like any bone condition. Laboratory tests are frequently negative and not wholly specific. While some authors claim that the radiological picture is of no diagnostic significance, others state that it offers pathognomonic signs. Diagnosis will be obtained through the combined assessment of clinical, radiological, laboratory and anamnestic data. Provenance from a rural area should reinforce the suspicion. Surgery, whether radical or conservative, is the key factor in treatment though local recurrences are common. Better results are obtained by combining surgery with Mebendazole for pre and postoperative prophylaxis. Large doses over a long period will give a better clinical course and reduce the incidence of recurrences. The prognosis is good for both sites as long as surgical treatment is given in good time.

PMID: 3601139 [PubMed - indexed for MEDLINE]

*****

http://www.ncbi.nlm.nih.gov/pubmed/12717286

J Radiol. 2003 Feb;84(2 Pt 1):143-6

Ultrasonographic, CT, and MRI findings of chest wall hydatidosis

[Article in French]

Ben Miled-M'rad K, Bouricha A, Hantous S, Zidi A, Mestiri I, El Hammami S, Djilani-Horchani H, Ghedira H, Belhabib D, Megdiche L, Hamzaoui A, Kilani T.

Service d'Imagerie Médicale, Pavillon III, CHU Abderrahmen Mami Ariana, Tunisie. khaoula.mrad@rns.tn.

The chest wall is an uncommon localization for hydatid disease even in countries where echinococcosis is endemic. Only isolated sporadic cases have been reported in the literature. We reviewed retrospectively 15 patients who underwent surgery for chest wall hydatid disease. Various imaging techniques were used for diagnosis of our cases. These included chest radiograph, thoracic ultrasonography, computed tomography and magnetic resonance imaging. Hydatid cyst involved soft tissues (n=5), ribs and vertebrae (n=5), ribs (n=4) and sternum (n=1). Imaging techniques were of value for diagnosis (radiographs and sonography) and for evaluation of the extent of involvement (CT and MRI). Chest wall hydatidosis requires surgical treatment but recurrence is frequent.

PMID: 12717286 [PubMed - indexed for MEDLINE]
 

The original article in French with images

http://www.masson.fr/masson/portal/bookmark?Global=1&Page=18&MenuIdSe...=

http://www.ncbi.nlm.nih.gov/pubmed/16918057?ordinalpos=1&itool=EntrezSyst...

Folia Med (Plovdiv). 2006;48(1):60-3

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

Stavrev VP, Poryazova EG, Chonova EV.

Department of Orthopedics and Traumatology, University Hospital St George, Medical University, Plovdiv, Bulgaria. vstavrev@yahoo.com

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", MedicalUniversity, 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.

PMID: 16918057 [PubMed - indexed for MEDLINE]