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Year : 2002  |  Volume : 12  |  Issue : 2  |  Page : 299-300
A case of incidentally detected retroperitoneal hydatid in a patient with splenomegaly


Department of Radiology, Government Medical College, Nagpur, India

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How to cite this article:
Mitra K, Taori K B, Mammen T, Ghonge N. A case of incidentally detected retroperitoneal hydatid in a patient with splenomegaly. Indian J Radiol Imaging 2002;12:299-300

How to cite this URL:
Mitra K, Taori K B, Mammen T, Ghonge N. A case of incidentally detected retroperitoneal hydatid in a patient with splenomegaly. Indian J Radiol Imaging [serial online] 2002 [cited 2019 Nov 18];12:299-300. Available from: http://www.ijri.org/text.asp?2002/12/2/299/28467
Sir,

Human hydatid disease is endemic in Central India and it presents a major health problem in sheep and cattle rearing countries. Hydatid disease involving the retro-peritoneum is rare and an isolated retroperitoneal hydatid cyst is extremely rare.

A 9-year old child presented in our out patient department with a history of fullness of the abdomen, intermittent dull aching pain and vague abdominal symptoms since few months and a history of on and off fever. Abdominal palpation revealed splenomegaly

With a clinical diagnosis of splenomegaly the patient was advised a barium study, which revealed a soft tissue opacity mass in the left hypochondrium and left lumbar region displacing the bowel loops to the opposite side. The Chest radiograph did not reveal any abnormality. The USG showed a large multiseptated cystic lesion in the abdomen behind the left kidney, which had displaced the kidney downwards and anteriorly. There was no evidence of any other cystic lesion in the abdomen. A diagnosis of incidentally detected retroperitoneal cystic lesion in the posterior pararenal space was kept with splenomegaly. A CT Scan was done for further characterization of the lesion. The CT study showed a large cystic mass lesion with multiple septations posterior to the left kidney which had displaced and rotated the left kidney laterally, caudally and externally. This cystic lesion did not show post contrast enhancement, fat density or calcific density. A final radiological diagnosis of incidentally detected isolated Retroperitoneal hydatid cyst in the posterior para-renal space with moderate splenomegaly. A differential diagnosis of a retroperitoneal lymphangioma was kept in mind. Investigations were carried out for the evaluation of splenomegaly and the patient was detected to be a case of chronic malaria and appropriate treatment was started. Surgery was done by midline incision through a trans peritoneal approach. The Cyst was confirmed to be posterior to the left kidney and was separate from the kidney, the cyst was delivered in toto. The Cyst was opened and multiple daughter cysts were delivered out confirming the diagnosis of Isolated Retroperitoneal hydatid cyst.

Isolated retroperitoneal hydatid cyst is very rare and the first case of this type to be studied by CT scan was reported in 1987[1]. It is defined as a zone of hydatidosis occurring in the fatty tissue in the space lying behind the posterior parietal peritoneum without any parasitic foci in other organs [2]. It usually presents as an abdominal mass and less frequently with concomitant compression syndromes. It can also rupture into great vessels like the aorta forming false aneurysms [3]. In one case it had presented as a retrocaval ureter [4]. Diagnosis is based on Immunodiagnostic tests and radiological features with a percutaneous puncture. In an endemic region of hydatid disease a diagnosis of hydatid cyst of the retroperitoneum must be entertained on coming across a multiseptated cystic retroperitoneal mass. Immunological tests and percutaneous aspiration can be used to confirm the diagnosis. Retroperitoneal lymphangioma are congenital malformations of the lymphatic system and are seen as unilocular or multilocular cysts with thick septations, 44% contain some debris. Treatment is surgery; azoles are useful for intra-operative ruptured cyst and to reduced the risk of recurrence.

 
   References Top

1.Menor - Serrano - F, Marti-Bonmati-L, Garcia-Aguayo-F, Gordo-Roman-G, Ballesta-Cunat-A, Isolated Retroperitoneal Hydatid cyst. J-Radiol. 1987 Mar; 68 [3]: 209-11.  Back to cited text no. 1    
2.el-Ouakdi-M, Ben-Fadhel-S, Ayed-M, Zmerli-S Primary Retroperitoneal Hydatid cyst. J-Urol-Paris. 1988; 94 [9-10] 445-8.  Back to cited text no. 2    
3.Hadijat-n; Graba-A; Mansouri-H Rupture of retroperitoneal hydatid cyst into the abdominal aorta. Ann-Vasc-Surg 1987 May; 1(4): 483-485.  Back to cited text no. 3    
4.Crundwell-MC; Blacklock-AR Retroperitoneal Hydatid cyst mimicking retrocaval ureter. Br-j-Urol. 1988 Jan; 81[1]; 168-9.  Back to cited text no. 4    

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Correspondence Address:
K Mitra
Department of Radiology, Government Medical College, Nagpur
India
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Source of Support: None, Conflict of Interest: None


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