This document describes a case of a 29-year-old male patient presenting with leg swelling, pain, and discharging sinuses on his right leg. Imaging showed multiple cystic lesions in the leg muscles. The patient underwent surgery where multiple hydatid cysts were drained and excised from the leg muscles. Histopathology confirmed the diagnosis of hydatid cysts. The patient was treated with albendazole and follow up imaging showed a residual collection that was drained conservatively. Hydatid cysts in muscles are rare but this case report discusses the presentation, diagnosis, and treatment of primary intramuscular hydatidosis.

1. INTERESTING CASE OF LEG
SWELLING WITH
DISCHARGING MULTIPLE
SMALL CYSTS
DR SHUBH NARAYAN
GHANGHORIYA
UNDER GUIDANCE OF:
DR M. KELA
PROFESSOR AND HEAD OF
DEPARTMENT
DEPARTMENT OF GENERAL
SURGERY,SRI AUROBINDO
MEDICAL COLLEGE AND PG
HOSPITAL

2. PATIENT DETAILS
 NAME : XXXX
 AGE : 29 YEARS OLD
 GENDER : MALE
 RESIDENT OF : MAHARAHTRA , AKOLA
 MARITAL STATUS : MARRIED

3. PRESENTATION :
29 y/o male patient came to
surgery OPD on 30/5/22
with complaints of pain and
swelling on the lateral
aspect of the right lower leg
since 1 month with a
discharging sinus since 8
days.

5. History of presenting illness:
 The swelling was gradually increasing in size
and extending from knee to right foot toe with
prominent point over lateral aspect of right leg
at distal 2/3 of leg.
 Patient went to local clinic at akola.
 Incision and drainage was done at an outside
hospital and e/o multiple cyst drained from the
incision site.
 Histopathology report not present with patient.
 Since then patient developed c/o continuous
drainage of cyst

6. Past history
 No past medical history.
 h/o and incision and drainage was done 8 days
back with e/o multiple cysts drained
 histopathological examination was sent but no
reports were present with the patient

7. Examination:
 Mild tenderness over calf region .
 Signs of inflammation were present.
 Tendernesss , redness , slight rise in
temperature.
 Cyst discharging sinus present over the right
leg lateral aspect
 Sinus opening of size : 2x2 cms on the lateral
aspect of right leg about 13 cms above the
lateral malleolus.

8. INVESTIGATIONS:
 CBC : 13.0/5.94/45.3/4500/1.36 LAC
 BLOOD GROUP : B POSITIVE
 RBS : 84
 UREA : 17
 CREATININE : 0.76
 S. ALP : 105
 SGOT : 64
 SGPT : 69
 PT/INR : 15/1.0
 S.ELECTROLYTES : 146/3.51/113
 SEROLOGY : NON REACTIVE

9. USG W/A:
 No bony involvement was seen.
X ray right lower limb :
 No significant abnormality detected

10. USG LOCAL REGION :
Evidence of an ill-defined heterogeneously hypoechoic
area of size 7.1x5.2x4.5 noted in the muscular
compartment of right lower leg region. This area contains
multiple well-defined anechoic round cystic lesions along
with multiple air foci noted within it, there is no obvious
internal vascularity noted inside these cystic lesion on
Doppler study.
A fistulous tract coursing through the skin & subcutaneous
tissues is seen communicating with the collection
.
Imaging findings

11. Ultrasound images
multiple well-
defined anechoic
round cystic lesions

12. no obvious internal
vascularity noted

13. Evidence of a loculated thick walled pocket of collection
noted in mid leg region in muscular compartment
(involving tibialis posterior, flexor hallucis longus) with
associated surrounding edema / myositis.
It measures 3.7 x 2.3 x7.7 cm in TR, AP, CC axis
No bony involvement seen.
MRI Brain and whole body STIR study do not reveal any
focal lesion or hydatid cyst.
MRI

15. Treatment :
Pre anesthetic check up was
done.
Surgical m/m : incision with
drainage of multiple cysts with
pericystectomy was chosen as
the preferred surgical treatment
done on 1/6/22.
Medical m/m : Treatment
involved 400 mg of albendazole
per day for 15 days before and

16. Surgical procedure :
Patient lying in supine position.
Incision made on below and above
the sinus tract and on lateral aspect
incision deepened layer by layer and
incision also made on medial aspect
and deepened.

17. Intraop findings :
Cavity of cyst , draining the cysts excised
and debridement of surrounding tissue
done, hemostasis achieved and wash given
with 3 % NS( hypertonic saline)

18. Evidence of :
Cavity present below the gastrocnemius
muscle which is draining cyst.

19. HISTOPATH FINDINGS:
MACROSCOPIC FINDINGS:
Multiple daughter cysts measuring 0.4
cm to 0.9 cm in diameter. Externally
glistening white, smooth cut section –
smooth and glistening white.
MICROSCOPIC :
The section shows lamellate acellular
eosinophilic cyst wall with inner
germinal layer and occasional brood
capsule.
IMPRESSION:
HYDATID CYST – RIGHT LEG

20. • The postoperative course of the patient was
favourable. However, 2 weeks later, the patient
complained of a slight pain on the back of the
right leg.
Despite the absence of hypereosinophilia,
pulmonary and cutaneous signs, a possible
relapse was discussed. Albendazole was
continued (400 mg twice per day) and
radiological controls were performed.
UE revealed a heterogeneous aspect of the
muscular tissue and local region use imaging
confirmed a relapse, ill defined residual
collection with internal septations of size 7.7 x
1.5 x 3 cm ~ 20 cc noted in intra muscular
compartment of right leg (within tibial posterior
muscles) with surrounding thickened edematous

21. • The collection was drained out by the
previous incision site by regular dressing and
was managed conservatively in ward.

22. Post operative day 17

23. DISCUSSION
Primary muscular HC is a rare
localization.
However, several cases of
isolated cyst have been reported
in upper and lower proximal
muscles.
To our knowledge, no reports of
multiple HC in the muscle have

24. differential diagnoses
lipoma,
calcified hematoma,
cold abscess or
soft tissue tumour.
Musculoskeletal echinococcosis should
always be suspected in patients originating
from endemic regions

25. CONCLUSION
 The signs and symptoms of the hydatid disease
vary according to the involved organ, the site, the
effects on the adjacent tissues, complications
after rupture, secondary infection, and
immunological reactions
 The first and most common symptom in our
patient was a slow growing painless mass, and
this symptom was compatible with the
literature.
 The helpful diagnostic and classification ways of
cysts are ultrasonography, ct, and mri
 Intramuscular hydatidosis have been
classified according to the gharbi classification

27. REFRENCES:
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28. REFRENCES:
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31. THANK YOU