Bony Hydatidosis of Femur Head - A Rare Case Report

Abstract

Introduction: Hydatid disease occurs due to Echinococcus in humans as they are intermediate host for tapeworm. The bone involvement is rare. Insidious nature and nonspecific nature of complaints make delay in diagnosis. Surgery is the mainstay of treatment with role of chemotherapy is as an adjunct treatment modality.

Case report: An 18-year-old male patient presented with the left groin pain and terminal restriction of hip movement for 1 year duration. The patient underwent open biopsy and histopathological examination of tissue specimen revealed hydatid cyst. The patient was started on albendazole and after 3 months, surgical curettage and removal of cysts were performed with application of bone cement. At 8 years follow-up, the patient is asymptomatic and doing well.

Conclusion: The treatment of osseous hydatid disease is challenging. High index of suspicion in endemic areas is required along with radiological and laboratory investigation to confirm the diagnosis. Timely and proper management can completely cure the patient without any residual pathology with full functional recovery.

Keywords: Echinococcus granulosus; albendazole; bony hydatidosis; femur head.

Figure 1

Radiograph of pelvis with bilateral hip-anteroposterior view showing lytic lesion in the left femur head extending up to proximal neck.

Figure 2

Axial computed tomography images showing the multiloculated lesion in the left femur head.

Figure 3

(a) Coronal MRI images showing the multiloculated lesions in the left femur head. (b) Sagittal MRI images showing the multiloculated lesions in the left femur head. MRI: Magnetic resonance imaging.

Figure 4

(a and b) Scolex visible in the histopathology specimen.

Figure 5

Radiograph of pelvis with bilateral hip-anteroposterior view after 3 months of biopsy and albendazole therapy.

Figure 6

Radiograph of pelvis with bilateral hip-anteroposterior view after curettage and cementing. The greater trochanteric osteotomy was fixed with two fully threaded cancellous screws.

Figure 7

(a) Radiograph of the left hip- anteroposterior view at 6 months post-operative. (b) Radiograph of the left hip-lateral view at 6 months post-operative.

Figure 8

(a) Radiograph of the left hip-anteroposterior view at 1 year post-operative. (b) Radiograph of the left hip-lateral view at 1 year post-operative.

Figure 9

(a) Radiograph of the left hip-anteroposterior view at 2-year post-operative. (b) Radiograph of the left hip-lateral view at 2-year post-operative.

Figure 10

Radiograph of the left hip- anteroposterior view at 8-year follow-up.

Figure 11

(a) Clinical photograph of patient at 8-year post-operative in cross-legged sitting. (b) Clinical photograph of patient at 8-year post-operative in squatting position.