India: A Rare Case of Pleurospinal Hydatid Cyst

A rare case has been discovered where a patient presented with numbness of lower limbs and was diagnosed as a tubercular pleurospinal lesion through MRI but turned out to be a pleurospinal hydatid cyst during surgery. The case, recently reported in Apollo Medicine, highlights the need for more intensive investigation of primary hydatid cysts and must not rely on MRI results.

“Whenever we see a problem like this in the spinal cord we always think of tuberculosis spine. So, there is a rare possibility of a hydatid cyst also we should keep in mind,” the lead author Prof. Dr. Kodeeswaran Marappan, Professor & HOD, Departments of Neurosurgery and Orthopaedics, Apollo First Med Hospital, Chennai, Tamil Nadu, India, told. He suggested that "it is a tapeworm infection/hygiene practices will avoid this illness."

The researchers suggest that MRI findings are not definitive of diagnosis and could mimic similar pathological conditions. The most common non-traumatic spinal cord compression in India is due to Tuberculosis, and always common causes are considered first.

Furthermore, they said that “Hydatid cyst is a preventable cause of spinal cord pathology as compared to other causes of spinal cord illness. Early identification, strategic surgical planning, and thorough follow-up are imperative to achieve superior results in case of pleurospinal hydatid cysts.”

Hydatid cyst represents a parasitic infection caused by the larval stage of the Echinococcus tapeworm. This condition primarily affects the liver and lungs, with direct involvement within the thorax, and is very rare. Taking care of hygiene can avoid this illness.

Despite the inception of advanced magnetic resonance imaging (MRI) techniques, it is difficult to reach a preoperative diagnosis as it mimics other similar infectious conditions.

Dr. Marappan and colleagues intended to shed light on this rare pathology of pleurospinal hydatid cyst as showcased in a 62-year-old female patient who was initially misdiagnosed as a tubercular pleurospinal lesion through MRI.

Case Details

The case concerns a female patient, aged 62 years, presented with a three-month history of progressive weakness, numbness of bilateral lower limbs, and difficulty in walking. She also complained of vague back pain for the past year. Neurologically, she displayed paraparesis, with reduced muscle strength (MRC grade 3/5 bilaterally) and impaired sensation below the D8 level.

MRI imaging reveals the presence of a T1 hypo, T2 hyperintense dumbbell-shaped pleurospinal multicystic lesion located at the D9-D10 vertebral level with spinal cord compression. Radiologists have given tuberculous/nonspecific abscess as a differential diagnosis.

During surgery, whitish cysts were detected revealing it to be a rare case of primary pleurospinal (thoracic) hydatid cyst which was later managed with full surgical excision of all the cysts.

Postoperatively, the patient showcased immediate improvement in motor strength and sensation and was given albendazole therapy for three months. After one year, the patient had no neurological defect. Furthermore, the 24-month follow-up revealed no evidence of reoccurrence and remained asymptomatic.

“Pleurospinal hydatid cyst is a very rare condition in clinical practice one can come across and as the diagnosis was made during the intraoperative period, so, always hydatid cyst is to be considered in mind as one of the diagnoses of spinal cord pathology,” mentioning the significance and rarity of the care, said Dr. Marappan.

The case illuminates the possibility that advanced Magnetic Resonance Imaging (MRI) could even miss the correct diagnosis of a pleurospinal hydatid cyst which resembles a tubercular pleurospinal lesion.

Reference

Priyadharshan KP, Marappan K, Mathew M, Mani AK, Vakamala HR, Jayamoorthy T. Pleuro-spinal Hydatid Cyst Masquerading as Spinal Tuberculosis: A Rare Case Report. Apollo Medicine. 2024;0(0). doi:10.1177/09760016241245254