EN
TÜRKÇE
Poster Display - 1
Costal hydatid cyst in a child with down syndrome: a rare and challenging diagnosis
Syrine Laribi 1, Myriam Ben Fredj 1, Samia Belhssan 1, Afef Toumi 1, Sawsen Chakroun 2, Maha Ben Mansour 2, Amine Ksia 1, Mongi Mekki 1, Mohsen Belghith 1, Lassaad Sahnoun 1
1 Pediatric surgery department, Fattouma Bourguiba Hospital.
2 Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital.
Introduction:
Hydatid disease, caused by Echinococcus granulosus, rarely affects bones, and costal involvement is exceptional, especially in pediatric patients. We report the case of a 12-year-old girl with Down syndrome and hypothyroidism, admitted for a left anterior thoracic subcutaneous mass.
Case presentation:
The history revealed a previous episode of spontaneous fistulization of a similar dorsal mass that had resolved without treatment. Clinical examination found a firm, non-tender, inflamed mass discharging pus. Laboratory tests showed normal inflammatory markers, and initial microbiological investigations including tuberculosis screening and pus culture were negative.
Ultrasound revealed a heterogeneous subpectoral collection with multiple anechoic cystic areas and a tract extending to the sternocostal joint. Thoracic CT scan demonstrated osteolytic lesions of the second left rib with surrounding soft tissue collection and bone sequestrum, suggesting an infectious or neoplastic process. Surgical drainage yielded purulent material containing translucent vesicles, raising the suspicion of a hydatid cyst. Histopathological examination confirmed the diagnosis, showing lamellar, acellular eosinophilic membranes consistent with hydatid cyst walls.
The patient underwent complete surgical excision of the cyst with curettage of the affected rib and pleural cavity cleaning. Medical treatment with albendazole was administered postoperatively. The clinical course was favorable. At three-year follow-up, the patient remained asymptomatic, with a normal control CT scan and negative hydatid serology, confirming complete recovery without recurrence.
Conclusion:
This case illustrates a rare location of hydatid disease that can mimic osteomyelitis or chest wall tumors. In endemic areas, hydatid disease should be considered in the differential diagnosis of chronic thoracic wall masses, even with atypical presentations and negative serology. Early diagnosis and radical surgical management are key to preventing recurrence and complications.