Primary Hydatid Cyst in Gastrocnemius Muscle
A 52-year-old female patient presented to the surgical out patient department (OPD) with the chief complaints of swelling of the right calf region associated with pain for six months. The swelling was gradually increasing in size. The pain was aggravated on walking. On examination, no associated tenderness was found. The radius of the swelling was 10 cm. The cyst did not disappear or reduce on flexion of the knee joint. Illumination test was negative. Fluctuation was present. Skin over the swelling was normal. X-ray of knee joint did not reveal any abnormality. Ultrasonography (USG) suggested atypical Backer′s cyst while color Doppler test did not detect any abnormality [Figures and ]. Routine blood tests (Hb%, total and differential leukocyte counts, serum creatinine and urea level, and fasting blood glucose) were found within normal limit. Chest X-ray (PA view) and electrocardiogram were also found within normal limit. She was planned for excision of cyst under spinal anesthesia.\nShe was explained with the nature of operation and anesthesia and a written consent was taken. She was given tab. alprazolam 0.25 mg at the night before the operation. On arrival to the operating room, an infusion of lactated Ringer′s solution was established and was put with routine monitoring, viz., electrocardiogram, noninvasive blood pressure, and oxygen arterial saturation. She was prepared for spinal anesthesia after preloading with Ringer′s Lactate at 10 ml/kg. Spinal anesthesia was given at sitting posture at L3-L4 inter-space using 25G Quincke spinal needle and 2.5 ml of 0.5% hyperbaric bupivacaine. The operation was done in prone position. Multiple lobular cysts were found within a large cystic cavity on opening of the calf muscle through longitudinal incision. She was given injection hydrocortisone 100 mg and injection chlorpromazine intravenously on suspicion of hydatid cyst. Savlon® was used as scolicidal agent because of the risk of spillage. The cyst was excised totally which contained 22 daughter cysts. The diagnosis of muscular hydatidosis was confirmed by histopathologic examination. Later, USG of liver was done which did not reveal presence of any space occupying lesion suggestive of hydatid cyst.\nThe postoperative course was uneventful and she was discharged from hospital on postoperative day 4. The patient received adjuvant oral treatment with albendazole (400 mg twice daily; each course lasting 4 weeks, being interrupted by 2 weeks off therapy) for 6 months for prevention of recurrences. Total and differential leukocyte count (to diagnose leukopenia and eosinophilia) and serum transaminase levels were monitored during the therapy. The reports were found to be within normal limits. One year after the operation during follow-up visit she was found to be in good health and without any signs of recurrence.