Hydatid Disease of the Left Femur

Osseous hydatid disease is a rare but serious condition. Treatment is difficult because of the progressive course of the bone involvement and generally admitted algorithm about osseous hydatid disease. We report a sixyear follow-up of a case with involvement of the left femur, treated with an unconnected surgical method and albendazole. In this patient a 1 cm segment of the cortex between the trochanteric region to supracondylar area of the left femur was removed. The medullary cavity of the left femur was irrigated for 5 minutes with 20% hypersaline solution, and removed without causing any damage. The medullary cavity was curettaged meticulously and irrigated for 6 minutes with 0.9% saline solution. The bone defect was filled with bone cement. Albendazole was administered during the postoperative period. At the sixth year postoperatively, the patient was pain free. All serological tests were normal. Radiologic evaluation showed no evidence of disease recurrence. Meticulous preoperative planning, excision of all the cysts, and an effective regimen of chemotherapy will reduce recurrence. Bone scintigraphy is an important diagnostic method during the follow-up period. Hydatid cyst disease is a parasitic disease caused by a cestode known as echinococci. The genus Echinococcus includes three species; Echinococcus multilocularis, Echinococcus vogeli and Echinococcus granulosus. Echinococcus granulosus is the most common cause of hydatid disease in man. The definitive hosts are dogs, foxes, and other carnivores. The tapeworms live in the small bowel of these hosts and infected ova are shed in the feces. When ingested by intermediate hosts such as man, sheep, or cattle, the larvae enter the portal circulation. The larvae eventually reach the liver, where of them most are trapped. Sometimes, larvae reach the lungs and other areas of the body and form cysts. The life cycle is completed when the definitive hosts consume infested viscera of the intermediate host. The primary hydatid disease of the bone, caused by Echinococcus granulosus is formed when the scoleces are localized in the bone, and it is seen in 1% to 2.4 % of the cases. The strong structure of osseous tissue limits the growth of the hydatid cyst, which spreads along medullar and trabecular channels. The trabeculae are slowly resorbed due to pressure without any cortical extension. The cysts extend to surrounding soft tissues if the bone cortex is eroded. The disease affects long bones, vertebral column, pelvis, and costae in order from least to most affected region. In general, the patients present to clinicians with local pain, swelling, or a pathologic fracture. Giant cell tumors, solitary bone cysts, aneurysmal bone cysts, fibrous dysplasia, bone metastasis, neurofibromatosis, and tuberculosis of the bone should be considered in the differential diagnosis of osseous hydatid disease. More recently, special diagnostic techniques Hydatid Disease of the Left Femur