Hydatid cyst of the neck. A case report

CASE REPORT
Hydatid cyst of the neck. A case report
and literature review
Reem Khalifa, Firas Nasser, Ahmed Elsetouhy, Ismail Farag
*
Hamad Medical Corporation, Qatar
Received 1 December 2015; accepted 28 January 2016
Available online 17 June 2016
KEYWORDS
Hydatid disease;
Neck;
Surgery
Abstract Echinococcosis or hydatid disease is a zoonotic infection caused by Echinococcus
granulosus. It has been recognized by humans for centuries, as it was described by Hippocrates more
than two thousand years as a ‘‘fluid-filled liver”, and the famous Arabian physician Al-Rahzes
described it, but it took till the 17th century when Francesco Redi illustrated that the hydatid cysts
of echinococcosis were of animal origin. Hydatid disease is endemic in the Middle East, India,
Africa, South America, New Zealand, Australia, Turkey and Southern Europe keeping in mind that
it can occur also in non-endemic countries because of the upsurge of emigration and trade. The
primary hosts are dogs. Intermediate hosts are sheep, cattle, horses and occasionally man.
Hydatid cyst develops most frequently in the liver (65%), the lungs (25%), and the remaining 10%
occurs in muscle, spleen, bones, kidneys, brain, eye, heart, and pancreas. Multiorgan involvement is
seen in 20–30% of the cases with involvement of the liver in all cases. Occurrence of hydatid cyst is extre-
mely rare in the head and neck region even in geographical areas where echinococcal infestation is fre-
quent. Only a few cases of hydatid cyst located in head and neck have been reported in the literature.
We will present our experience in treating a case of hydatid cyst located in the neck area, which is
considered one of the few cases published due to the relative rarity of the disease in the fore mentioned
anatomical location.
Ó2016 Egyptian Society of Ear, Nose, Throat and Allied Sciences. Production and hosting by Elsevier
B.V. All rights reserved. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
Echinococcosis or hydatid disease is a zoonotic infection
caused by Echinococcus granulosus.
1
It has been recognized
by humans for centuries, as it was described by Hippocrates
more than two thousand years as a ‘‘fluid-filled liver”, and
the famous Arabian physician Al-Rahzes described it, but it
took till the 17th century when Francesco Redi illustrated that
the hydatid cysts of echinococcosis were of animal origin.
2
Hydatid disease is endemic in the Middle East, India, Africa,
South America, New Zealand, Australia, Turkey and Southern
Europe
3,4
keeping in mind that it can occur also in non-
endemic countries because of the upsurge of emigration and
trade.
5
The primary hosts are dogs. Intermediate hosts are
sheep, cattle, horses and occasionally man.
1
*Corresponding author at: Hamad Medical Corporation, P.O. BOX
3050, Qatar. Tel.: [phone].
E-mail addresses: [email protected] (R. Khalifa), fnasser@
hamad.qa (F. Nasser), [email protected] (A. Elsetouhy), ifarag@
hamad.qa (I. Farag).
Peer review under responsibility of Egyptian Society of Ear, Nose,
Throat and Allied Sciences.
Egyptian Journal of Ear, Nose, Throat and Allied Sciences (2016) 17, 103–105
HOSTED BY
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Egyptian Journal of Ear, Nose, Throat and Allied
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http://dx.doi.org/10.1016/j.ejenta.2016.01.002
2090-0740 Ó2016 Egyptian Society of Ear, Nose, Throat and Allied Sciences. Production and hosting by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Hydatid cyst develops most frequently in the liver (65%),
the lungs (25%), and the remaining 10% occurs in muscle,
spleen, bones, kidneys, brain, eye, heart, and pancreas.
6,7
Multiorgan involvement is seen in 20–30% of the cases with
involvement of the liver in all cases.
8
Occurrence of hydatid
cyst is extremely rare in the head and neck region even in geo-
graphical areas where echinococcal infestation is frequent.
Only a few cases of hydatid cyst located in head and neck have
been reported in the literature.
9,10
We will present our experience in treating a case of hydatid
cyst located in the neck area, which is considered one of the
few cases published due to the relative rarity of the disease
in the fore mentioned anatomical location.
2. Case report
A 20 year old Nepalese male, who is not known to have any
medical history, presented to the Oral and maxillofacial
Surgery department in Hamad Medical Corporation, Doha,
State of Qatar, with a chief complaint of a right neck swelling,
noted about 6 month back. The general condition of the
patient was good; he had no history of fever or weight loss.
The patient lived almost his entire life in his home country
Nepal, before recently moving to Doha. He reported that the
swelling was gradually increasing in size but never caused pain
or discharge.
Clinical examination revealed a well-defined, non-tender
right upper neck swelling of about 5 cm in diameter, systemic
examination was unremarkable, Fig 1.
Computed Tomography Scan showed a well-defined large
cystic lesion involving the right upper neck area, of about
3.3–4.5 cm in size and the report favored an infected branchial
cyst, laboratory investigations were within normal values,
Figs. 2 and 3 shows axial and coronal views (respectively) of
the cyst, excisional biopsy was planned and discussed with
the patient. The surgical procedure was successfully executed
and the postoperative course was uneventful.
Other body parts were scanned, and a calcified hydatid cyst
was found in the abdomen, for which he was referred to the
infectious disease team for further management.
3. Discussion
Hydatid cyst is endemic in the Middle East, India, Africa,
South America, New Zealand, Australia.
4
Though the State of Qatar is not among the endemic coun-
tries for the disease, nevertheless, this patient, in addition to
some other cases in other anatomical locations, were reported,
and the reason for that is the high emigration rate within the
last 3 decades due to the fast expansion in the country.
Al-Ani et al reported a Case of Echinococcosis in a preg-
nant lady with an unusual presentation. The disease occurred
in the lungs and liver and was treated surgically following
delivery. According to same study echinococcal disease is seen
mainly in people coming from endemic areas and the disease is
rare among Qataris.
11
Occurrence of hydatid cyst is extremely rare in the head and
neck region even in geographical areas where echinococcal
infestation is frequent, and only few cases have been reported
in the literature.
6,7
Hydatid cysts are usually not considered in
Figure 2 Axial Post contrast CT neck showing a well-defined
cystic lesion medial to the right angle of mandible showing
enhancing wall of uniform thickness.
Figure 3 Coronal post contrast CT images of the neck showing
the cystic lesion deep to the right angle of the mandible displacing
the right submandibular gland superomedially.
Figure 1 3D demonstration of the right upper neck mass.
104 R. Khalifa et al.

the differential diagnosis of head and neck cystic swellings,
especially in non-endemic areas in the absence of hydatid
disease elsewhere in the body. The rarity of the disease in this
anatomical location presents a diagnostic difficulty for the
physician if he or she is not familiar with the disease.
9
If the cysts ruptured while in the body, whether during sur-
gical extraction or by some kind of trauma to the body, the
patient would most likely go into anaphylactic shock.
12
This
event didn’t occur in the patient included in the study.
Standard treatment modality is surgical removal of the
cysts combined with chemotherapy using albendazole and/or
mebendazole before and after surgery, albendazole is preferred
twice a day for 1–5 months.
13
4. Conclusion
When dealing with well-defined cystic lesions in the head and
neck area hydatid cyst should be considered in the differential
diagnosis even in non-endemic areas due to the high emigra-
tion rates. Care should be taken by the operating team during
surgery as ruptured cyst may cause anaphylactic shock.
This case report is granted for publication with reference:
MRC/1367/2015.
Conflict of interest
None declared.
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