Spinal hydatid with meralgia paresthetica in a female: A rare case report
A 45-year-old female presented with swelling in the thoraco-lumbar region which had been present for last 1 year but had enlarged rapidly over the last 3 months. She denied any recent weight loss or pain associated with the mass. She also denied any fever or blunt trauma to the area. Apart from its size, it did not give any problem except that since the last few weeks she had started experiencing tingling sensation over her anterior-lateral aspect of left thigh and slight weakness in her left lower limb resulting into a limp. She was otherwise in good health except for mild hypertension for which she took no medication. On general examination, she was afebrile and hemodynamically stable. Local examination, revealed a large swelling, of size 30 × 25 × 25 cm in the thoraco-lumbar region which was soft, lobulated and non tender. Its border was well defined. It extended proximally upto the 8th thoracic vertebrae and distally upto 5th lumbar vertebrae. There were no signs of inflammation. The overlying skin was freely mobile with no venous engorgement. The mass was mobile in all directions []. Other systemic examination was normal. Neurological examination did not reveal any significant finding except for sensory loss over the antero-lateral aspect of left thigh and grade 3 power in the flexors of left hip joint. Straight leg raising test was negative. An initial diagnosis of lipoma was considered and radiological investigations were planned. Local USG of swelling was suggestive of hydatid cyst in subcutaneous tissue with membranes, septations and daughter cysts within the cystic cavity. No primary in abdomen or lungs was found. X-ray lumbo-sacral spine anteroposterior (AP) view was suggestive of destruction of spinous process and left pedicle of L1-L2 vertebrae []. Further Magnetic resonance imaging (MRI) of thoraco-lumbar spine was planned which revealed a well defined lesion with daughter cyst involving subcutaneous tissue of back, paraspinal muscle, post neural arch segment of D12-L2 with extradural extension into spinal canal at D12-L2 level [].\nThe patient underwent T12 to L2 laminectomy with total cyst excision with membrane. Extradural space showed multiple pearly white cysts compressing the dural sac. All the cysts were extirpated without rupture. The operative field was soaked with hydrogen peroxide wetted patties for a few minutes and then washed with normal saline. Histopathological examination confirmed the diagnosis of hydatid cyst []. Postoperative period was uneventful. Albendazole was given for a period of three months. There was no further weakness and tingling sensation over the lower extremity after 1 month of treatment. Also, there was no recurrence during the follow-up period of two years.