Journal of Radiology
Open Access

Computed tomography; Right Illiac Fossa

Tape worm, dog tape worm or hydatid worm also known as Echinococcus granulosus is a zoonotic parasite that penetrate into small intestines of animals, which then passes on to the intermediate host (such as livestock and humans) via stool. The life cycle of E. granulosus include dogs and wild animals as a definitive host for the adult tapeworm where parasites become mature and reproduce. Half of its life cycle completes in zoonotic animals and half occurs in intermediate host. The larval stage begins in intermediate host which results in echinococcal cysts [1, 2]. Though these cysts are slow growing but can cause serious clinical complications involving lungs, liver, skeleton (0.5-2%) and 50% of which involves spine. The infestation of Hydatid cyst occur by direct extension from pulmonary or pelvic region, spinal hydatid cyst manifest itself in thoracic region more commonly than lumber region, beside these infestations, sacral hydatid cysts which rarely presents in clinical settings are missed by most of the clinicians due to differential list of paralysis and rarity of the disease presentation [3].

A 50 years old female presented to us with low backache and lower limbs pain for last 5 years, previously she had hysterectomy and histopathology revealed cervicitis, adenomyosis, and leiomyoma. Her clinical symptoms did not improved as a result follow up ultrasound revealed multiloculated cystic lesions in pelvis, one in presacral region and another in RIF close to psoas muscle. This lesion in RIF was connected to the presacral lesion through a narrow pedicle. The presacral lesion has invaded and destroyed the sacrum (Figure 1) with intraspinal extension. The complementary CT images revealed almost complete destruction of the sacrum (Figure 1).

figure 1: CT images reveal the presence of hydatid cysts present in sacral region A-D. Complementary CT image shows complete destruction of the sacrum C.

Till date in most of the reported cases the primary source of Hydatid cyst is liver and lungs [6]. Involvement of other organs especially lumber region is very rare. Neither surgical intervention nor medical treatment is generally effective for hydatid cyst of bone or more specifically sacrum. Presurgical use of albendazole is the drug of choice against the sporadic echinococcus infestations or it can reduce the risk of recurrence [7-9].

Till date five cases of hydatid cysts are reported which is associated with sacrum [2, 3, 9, 11-13]. Patient with symptoms such as sciatica, accompanied with lower backache, and with lower limb must be correlated with hydatid cyst confirm through CT scan combine with MRI, and it should be included in a differential diagnosis when such cases are encountered. A complete clinical history of the patient is a gold standard in radiological findings of such disease.

The authors are deeply grateful to the participants whose time and effort made this study possible. We also appreciate the patients for their willingness and providing us the history. We also acknowledge the Department of Radiology and its technical staff who provided us the CT and MRI films.

Conflicts of Interest

None

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