Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 2940

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     

 

 Table of Contents    
MUSCULOSKELETAL  
Year : 2011  |  Volume : 21  |  Issue : 1  |  Page : 60-62
Soft tissue cysticercosis - Ultrasonographic spectrum of the disease


Department of Radiodiagnosis, MS Ramaiah Medical College and Hospital, Bangalore, India

Click here for correspondence address and email

Date of Web Publication22-Jan-2011
 

   Abstract 

This case series emphasizes the role of USG in the diagnosis of isolated soft tissue cysticercosis. We assessed its value for identifying features such as the location of the cyst, the presence or absence of abscess, and the presence or absence of a scolex within the cyst. Three USG patterns were seen and are described.

Keywords: Cyst; scolex; soft tissue cysticercosis; ultrasonography

How to cite this article:
Naik D, Srinath M G, Kumar A. Soft tissue cysticercosis - Ultrasonographic spectrum of the disease. Indian J Radiol Imaging 2011;21:60-2

How to cite this URL:
Naik D, Srinath M G, Kumar A. Soft tissue cysticercosis - Ultrasonographic spectrum of the disease. Indian J Radiol Imaging [serial online] 2011 [cited 2019 Nov 15];21:60-2. Available from: http://www.ijri.org/text.asp?2011/21/1/60/76059

   Introduction Top


Cysticercosis is the most common parasitic infection of the soft tissues. Cysticercosis is endemic in Mexico, Central and South America, Asia, India, sub-Saharan Africa, and China. [1],[2],[3] Due to increasing population mobility, cases of cysticercosis are now also being increasingly seen in developed countries. [3] Cysticercosis can affect various organs, including the brain, spinal cord, orbit, muscle, subcutaneous tissue, and heart. [4],[5] Human beings become occasional hosts of Taenia solium larvae, either via drinking of contaminated water or by eating uncooked/undercooked vegetables or pork. [3] The clinical manifestations vary, depending on the site of larval encystment. USG is an inexpensive, readily available, and radiation-free modality for the diagnosis of soft tissue cysticercosis.


   Materials and Methods Top


Between May 2008 and October 2009, there were 17 cases of isolated soft tissue cysticercosis diagnosed solely by USG at our institute. Two cases did not come back for follow-up USG after medical treatment.

USG was performed with a Voluson-730 scanner (GE Healthcare), using a 12 MHz linear transducer. The USG findings evaluated were cyst size, shape, and margin; presence of scolex; presence of abscess/surrounding inflammation; and location of the lesion. Follow-up USG to look for resolution was performed in six patients who received medical treatment. In the other nine patients, excision and biopsy were performed due to the presence of abscess.


   Results Top


The most common location for soft tissue cysticercosis was in the skeletal muscles of the upper extremities [Table 1], seen in ten cases. The mean age of the patients was 28.2 years (range: 9-52 years). Out of the 15 patients, seven were vegetarian and eight were non-vegetarian. Ten of the fifteen cases were females. The most common USG appearance was that of a cyst containing a scolex within and with surrounding abscess [Figure 1] and [Figure 2]; this picture was seen in nine patients. The second most common appearance, which was seen in five patients, was that of a cyst containing a scolex within and with surrounding edema [Figure 3]. The least common appearance, which was seen in only one of the patients, was that of an irregular cyst with no scolex within and with surrounding edema [Figure 4].
Table 1 :Demographic profile, clinical diagnosis, and sonographic features of soft tissue cysticercosis

Click here to view
Figure 1 :USG shows a cyst (arrow) with a scolex (arrowhead) and surrounding abscess (curved arrow)

Click here to view
Figure 2 :USG shows an eccentric cyst (arrow) with scolex (arrowhead) within and surrounding thick-walled abscess (curved arrow)

Click here to view
Figure 3 :USG shows a cyst (curved arrow) with scolex (arrow) within and surrounding edema (arrowhead)

Click here to view
Figure 4 :USG shows an irregular cyst (arrow) with no scolex within but with surrounding edema (arrowhead)

Click here to view


Out of the 15 patients, six were treated conservatively with albendazole or praziquantel and follow-up USG was done at 15 days and at three months. The follow-up USG done at 15 days showed resolution of edema, while the follow-up USG done at three months showed complete resolution of the cyst and edema. Nine of the fifteen patients had abscess and therefore underwent surgical excision and the diagnosis of cysticercosis was histopathologically confirmed.


   Discussion Top


Cysticercosis in humans is caused by consumption of food or water contaminated with viable eggs of T. solium or regurgitation of eggs into the stomach from the intestine of people harboring a gravid worm. [1],[2] If the eggs contaminate food sources, upon ingestion they develop into larvae and result in cysticercosis. [4] Hence, even people who do not consume pork, including vegetarians, can develop cysticercosis; [1] cysticercosis is not solely caused by consumption of infested pork. Cysticercosis can affect various organs, including brain, spinal cord, orbit, muscle, and heart. [1] In this study, we have focused on isolated soft tissue cysticercosis.

High-frequency USG has become relatively inexpensive and is a readily available and reliable diagnostic modality for the diagnosis of soft tissue cysticercosis. The most common USG appearance of soft tissue cysticercosis that we encountered in this study was that of an intramuscular abscess with an eccentrically situated typical cyst with a scolex within; this picture was seen in nine patients. This appearance may be due to chronic intermittent leakage of fluid from the cyst due to degeneration of the cyst, resulting in a chronic inflammatory response with a fluid collection around the cyst. [2],[3],[6] The second most common appearance was that of a typical cysticercosis cyst with a scolex within and surrounding mild edema but no abscess. Such patients may present with subcutaneous nodules or pseudohypertrophy of muscles if multiple cysts are present. [2],[6] The least common appearance was that of an irregular cyst with no scolex within but with minimal fluid surrounding the cyst on one side indicating leakage of fluid. [2],[6] The non-visualization of the scolex may be due to escape of the scolex outside the cyst or partial collapse of the cyst during larval death. [2],[6] Such patients present with myalgia. [2],[6]

The clinical features depend on the location of the cyst, the cyst burden, and the host reaction. [1],[4] Subcutaneous cysticercosis may cause painless or painful subcutaneous nodules. [1] Muscular cysticercosis may present clinically with myalgia, pseudotumor or mass and pseudohypertrophy. [2],[6],[4] Clinically, soft tissue cysticercosis can be misdiagnosed as lipoma, epidermoid cyst, abscess, pyomyositis, tuberculous lymphadenitis, neuroma, neurofibroma, sarcoma, myxoma, ganglion, or fat necrosis. [7] Since it is a common soft tissue infection, clinicians should always consider cysticercosis in the differential diagnosis whenever a patient presents with painful or painless swelling of long duration. USG is the initial and most reliable diagnostic modality for a soft tissue swelling. [8]

MRI is also used to diagnose soft tissue cysticercosis, since many patients with soft tissue swelling often go directly for MRI. [6],[7],[9] Cysticercosis is seen as a cystic lesion that appears hyperintense on T2W and hypointense on T1W images. Peripheral rim enhancement of the cyst wall is also known. Intramuscular cysts are oriented in the direction of the muscle fibers. [9] The scolex is also appreciated as a tiny hypointense speck within the hyperintense cyst [9] The diagnosis of cysticercosis can be confirmed by fine-needle aspiration cytology (FNAC) or biopsy, which shows the detached hooklets, scolex, and fragments of the spiral wall of Cysticercosis cellulosae. [8],[10] Sometimes, the larval parts may not be seen in the specimen, but an inflammatory reaction consisting of large numbers of eosinophils and histiocytes can still be seen. [8]

Treatment of soft tissue cysticercosis depends on the location of the cysts. [1] Surgical excision is done for isolated skeletal muscle or soft tissue cysticercosis associated with abscess. [1],[4] Cysts that are not associated with abscess can be treated with antihelminthic medications such as albendazole or praziquantel. [3],[4] Follow-up USG is done after three weeks of antihelminthic medication to look for resolution of the lesion.

Cysticercosis, thus, should always be part of the differential diagnosis of subcutaneous and intra-muscular swellings in India. USG is a good modality for diagnosing soft tissue cysticercosis.

 
   References Top

1.Kraft R. Cysticercosis: An emerging parasitic disease. Am Fam Physician 2007;75:91-6,98.  Back to cited text no. 1
    
2.Vijayaraghavan SB. Sonographic appearances in cysticercosis. J Ultrasound Med 2004;23:423-7.  Back to cited text no. 2
[PUBMED]    
3.Sidhu R, Nada R, Palta A, Mohan H, Suri S. Maxillofacial Cysticercosis - Uncommon appearance of a common disease. J Ultrasound Med 2002;21:199-202.  Back to cited text no. 3
[PUBMED]    
4.Mittal A, Das D, Aiyer N, Nagaraj J, Gupta M. Masseter cysticercosis - a rare case diagnosed in ultrasound. Dentomaxillofac Radiol 2008;37:113-6.  Back to cited text no. 4
    
5.Bhalla A, Sood A, Sachdev A, Varma V. Disseminated cysticercosis: a case report and review of literature. J Med Case Reports 2008;2:137.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Asrani A, Morani A. Primary sonographic diagnosis of disseminated muscular cysticercosis. J Ultrasound Med 2004;23:1245-8.  Back to cited text no. 6
[PUBMED]    
7.Jhankaria BG, Chavhan GB, Krishnan P, Jhankaria B. MRI and ultrasound in solitary muscular and soft tissue cysticercosis. Skeletal Radiol 2005;34:722-6.  Back to cited text no. 7
    
8.Smiti S, Sripathi H, Naik L. Unusual location of cysticercus lesions in soft tissue - report of three cases. Indian J Radiol Imaging 2003;13:157-8.  Back to cited text no. 8
  Medknow Journal  
9.Tripathy SK, Sen RK, Sudes P, Dhatt S. Solitary cysticercosis of deltoid muscle in a child: The diagnostic dilemma and case report. J of Orthopaedics 2009;6:e11.  Back to cited text no. 9
    
10.Arora VK, Gupta K, Singh N, Bhatia A. Cytomorphologic panorama of cysticercosis on fine needle aspiration. A review of 298 cases. Acta Cytol 1994;38:377-80.  Back to cited text no. 10
[PUBMED]    

Top
Correspondence Address:
Deepti Naik
Department of Radiodiagnosis, MS Ramaiah Medical College and Hospital, MSRIT Post, MSR Nagar, Bangalore - 560 054
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.76059

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]

This article has been cited by
1 Hepatic cysticercosis: a rare entity
Vikas Chaudhary,Shahina Bano,Praveen Kumar,Mahender Kaur Narula,Rama Anand
Abdominal Imaging. 2014;
[Pubmed] | [DOI]
2 Masseteric cysticercosis with abscess formation: A diagnostic dilemma
Swathi Muthyala,Kotha Vamshi Krishna,Tatikonda Venkat Kishan,Nuthalapati Sri Bhuvana,R.S. Moorthy
Medical Journal Armed Forces India. 2013;
[Pubmed] | [DOI]
3 Role of ultrasonography and magnetic resonance imaging in the diagnosis of intramuscular cysticercosis
Tripathy, S.K. and Sen, R.K. and Akkina, N. and Hampannavar, A. and Tahasildar, N. and Limaye, R.
Skeletal Radiology. 2012; 41(9): 1061-1066
[Pubmed]
4 Role of ultrasonography and magnetic resonance imaging in the diagnosis of intramuscular cysticercosis
Sujit Kumar Tripathy,Ramesh Kumar Sen,Narendranadh Akkina,Aravind Hampannavar,Naveen Tahasildar,Rajiv Limaye
Skeletal Radiology. 2012; 41(9): 1061
[Pubmed] | [DOI]
5 A rare case of hepatic cysticercosis
Sathyanarayanan, V., Sambhaji, C., Saravu, K., Razak, A., Polnaya, A., Rao, S.N.
# # Asian Pacific Journal of Tropical Biomedicine. 2011; sup 1: 141-142
[Pubmed]
6 A rare case of hepatic cysticercosis
Vishwanath Sathyanarayanan,Charudutt Sambhaji,Kavitha Saravu,Abdul Razak,Ashwin Polnaya,SN Rao
Asian Pacific Journal of Tropical Biomedicine. 2011; 1(1): S139
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed13275    
    Printed191    
    Emailed0    
    PDF Downloaded1163    
    Comments [Add]    
    Cited by others 6    

Recommend this journal