Two hydatid cysts in the psoas muscle of a 40-year-old female: A rare case report from Syria

Two hydatid cysts in the psoas muscle of a 40-year-old female: A rare case report from Syria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Two hydatid cysts in the psoas muscle of a 40-year-old female: A rare case report from Syria Hazem Arab, Yousef Alsaffaf, Osama Kattan, Saleem Khallouf This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4139407/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hydatid disease, a zoonotic infection common in pastoral areas, can affect any human organ. Muscular involvement, especially in the psoas muscle, is rare, comprising only 1-3% of cases, even in endemic regions. The presence of multiple cysts is even rarer. Clinical presentation varies, making them challenging to diagnostic. Surgical intervention is the primary treatment for psoas hydatid cysts. Case presentation: A 40-year-old female from a rural area presented with fatigue and abdominal pain, without constipation or changes in appetite. Physical examination revealed tenderness in the right hypochondrium. Her medical history included tonsillectomy twenty years ago, cesarean delivery two years ago, and pulmonary hydatid cystectomy seven years ago. Ultrasound detected a retroperitoneal hydatid cyst, while a multi-slice CT scan showed a hydatid cyst within the left psoas major muscle and an additional cyst in the anterior and lateral portions of the left psoas major muscle. Surgeries successfully removed two cysts from the left psoas major muscle, and the patient was discharged in good condition two days post-surgery. Conclusions: This case highlights the rarity of psoas major muscle hydatid cysts in a middle-aged woman from a rural area. Early recognition, accurate radiological assessment, and proper surgical treatment are crucial for positive outcomes and averting complications like infection, compression of nearby structures, or anaphylactic reactions. Hydatid disease Psoas muscle Right hypochondrium tenderness retroperitoneal hydatid cyst Hydatidosis Echinococcus granulosus Case report Figures Figure 1 Figure 2 Background Hydatid disease HD, a zoonotic parasitic infection commonly found in pastoral regions, it can affect any human organ [ 1 ]. The occurrence of muscular HD, particularly affecting the psoas muscle, is considered rare and exceptional even in endemic regions, representing only 1–3% of cases [ 2 ]. The development of multiple cysts is an even rarer phenomenon. The clinical presentation of psoas hydatid cysts can vary, making them challenging to diagnosis. Surgery is the mainstay of treatment for psoas hydatid cysts [ 3 , 4 ]. In this case study, we present a 40-year-old female from a rural area with two hydatid cysts in the psoas muscle. Case presentation A 40-year-old female from a poverty rural area, presented to the Department of General Surgery with fatigue and abdominal pain without constipation or change in appetite. Physical examination revealed right hypochondrium tenderness. Vital signs were within normal range. The patient had a history of tonsillectomy twenty years ago, cesarean delivery two years ago, and pulmonary hydatid cystectomy seven years ago. The laboratory test was performed and were in normal range (see Table 1 ). Ultrasound showed a retroperitoneal hydatid cyst below the left kidney with a duplicated and thickened wall measuring (77*110) mm (see Fig. 1). A multi-slice CT showed a thick-walled, homogenous, low-density hydatid cyst measuring about 70 mm in diameter within the left psoas major muscle, extending beyond the muscle boundaries from the level of the 3rd lumbar vertebra to the 5th lumbar vertebra. An additional cyst was identified within the anterior and lateral portion of the left psoas major muscle at the level of the 2nd lumbar vertebra, measuring approximately (17 * 39) mm (see Fig. 2). After consulting urologists, under general anesthesia, a transverse incision was performed on the left pararectal approach with retro-peritoneal passage. Two hydatid cysts were dissected from the psoas major muscle, and cystectomy was performed. The patient was discharged in good condition two days after the operation. Table 1 laboratory test before surgical operation. Test Value Normal Range White blood cells (10 3 /µl) 6.05 4.00–10.00 LYM (%) 25.6 15.0–50.0 GRA (%) 62,8 35.0–80.0 MID (%) 11.6 2.0–15.0 LYM (10 3 µl) 1.55 0.5-5.0 GRAN (10 3 µl) 3.80 1.2-8.0 MID (10 3 µl) 0.70 0.1–1.5 Red blood cells (10 6 µl) 4.60 3.5–5.5 Hemoglobin (g/dl) 12.2 12.0–16.0 Hematocrit (%) 39.3 36–46 MCV (fl) 85.4 80–100 MCH (pg) 26.4 25–35 MCHC (g/dl) 31.0 31.0–38.0 Platelet count (10 3 µl) 399 150.000-400.000 Fasting Glucose (mg/dl) 89 70–110 Creatinine (mg/dl) 0.7 0.6–1.2 ALT (U/l) 19 10–60 AST (U/l) 12 10–50 Amylase (U/l) 130 30–300 HBsAg Negative N/A MCH: Mean corpuscular hemoglobin, MCV: Mean corpuscular volume, MCHC: Mean corpuscular hemoglobin, ALT: Alanine transaminase, AST: Aspartate transaminase. Discussion Hydatid disease, also known as hydatidosis, is a zoonotic condition caused by the development of the larval form of canine tenia (Echinococcus granulosus) in the host’s organism. The definitive host of this tenia is dog, whereas the development in human is accidental by consumption of parasitized viscera, particularly the liver and lungs of the intermediate host (sheep) [ 5 ]. Echinococcus granulosus is the most common causative agent, while Echinococcus alveolaris is rare [ 6 ] It is endemic and constitutes a real public health problem in regions such as the Mediterranean, Middle East, South America, New Zealand, and Australia, predominantly affecting rural and poor populations [ 3 , 4 , 5 ]. While primary cysts can occur anywhere in the body, they are most frequently found in the liver (55–70%) and lungs (20–30%), with muscular tissue involvement accounting for only 2–3% of cases [ 4 ]. The muscular HD is a rare affection and the effect of the psoas seems exceptional; even in country of endemic disease. The efficient filtration mechanisms of the liver and lungs make it challenging for echinococcal larvae to reach musculoskeletal tissues. Additionally, the high lactic acid content and mechanical factors in muscles deter parasite growth [ 1 , 2 ]. Psoas muscle hydatid cysts typically manifest during childhood and young adulthood as painless muscle masses. Clinical symptoms can vary from nonspecific complaints to severe complications like anaphylaxis and death. Complications of psoas muscle hydatid cysts may include superinfection, nerve injuries, ureteral compression, and other serious consequences [ 2 ]. Imaging plays a crucial role in diagnosing and assessing hydatid disease. Ultrasound is often the initial diagnostic tool with a high reliability rate of 96%, The ultrasound appearance reproduces the stages of Gharbi’s classification and the stage of the disease. While CT scan is essential for deep-seated cysts such as those in the psoas muscle [ 3 , 5 ]. Magnetic resonance imaging (MRI) may be utilized in cases where diagnosis remains uncertain [ 5 ] Biological testing aids in confirming the diagnosis particularly in challenging cases, and monitoring treatment progress. [ 3 ]. The choice of treatment modalities depends on the cyst’s anatomical location, its relation to major anatomical structures, the number of cysts, the patient’s general health status, and the surgeon’s experience. If a preoperative diagnosis of hydatid cyst is made, the best therapeutic option should be surgery, although percutaneous treatment may have a role. For cysts localized in the psoas muscle, the lumbar extraperitoneal approach is the safest access in order to avoid peritoneal dissemination. The greatest danger for the patient (especially if hydatid disease is not suspected preoperatively) is dissemination with possible secondary implant and anaphylactic reaction. It is obvious that every measure must be taken to avoid dissemination of the disease [ 2 , 4 ]. The use of supplementary chemotherapy with anti-helminthic drugs for skeletal muscle hydatid disease remains controversial, lacking evidence-based recommendations [ 7 ]. In this particular case, we describe a rare occurrence of a 40-year-old female from a rural area presenting with two hydatid cysts in the psoas muscle. Conclusion This case highlights the rare occurrence of hydatid cysts within the psoas major muscle of a middle-aged female from a rural background, Early recognition, accurate radiological assessment, and appropriate surgical intervention are pivotal in achieving favorable outcomes and preventing potential complications associated with hydatid cysts, such as infection, compression of adjacent structures, or anaphylactic reactions. Declarations Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Availability of data and materials: The materials used during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: No funding applicable. Authors' contributions: H.A. collected the patient’s data and writing – original draft. Y.A. collected the patient’s data and writing – original draft. O.K. collected the patient’s data and writing – original draft. S.K. collected the patient’s data, revised the manuscript, performed the procedure, and supervised the study. Acknowledgements: None. References Jia Q, Wu S, Guo J et al. Giant muscle hydatid in lower extremity: a rare case with neurological symptoms as the first manifestation. BMC Infect Dis. 2023;23(1):645. Published 2023 Oct 2. 10.1186/s12879-023-08616-y . Merad Y, Derrar H, Zeggai A, Belkacemi M, Belmokhtar Z, Adjmi-Hamoudi H. A rare primary hydatid cyst of the psoas muscle in a rural setting: A case presentation. Ann Med Surg (Lond). 2020;59:86–8. 10.1016/j.amsu.2020.09.002 . Published 2020 Sep 9. Mhand M, Ramdani A, Khomssi N, et al. Hydatid cyst of the psoas: case report and review of literature. Ann Med Surg (Lond). 2023;85(3):424–6. 10.1097/MS9.0000000000000087 . Published 2023 Mar 9. Wani I, Wani RA, Alam Wani K. Primary hydatid of psoas muscle. Urol Ann. 2010;2(2):89. 10.4103/0974-7796.65112 . El Khassoui A, Aghoutane EM, Salama T, El Fezzazi R. Psoas Hydatid Cyst in Children: A Rare Localization about a Case. Case Rep Pediatr. 2021;2021:1961509. Published 2021 Nov 6. 10.1155/2021/1961509 . Şimşek S, Hattapoğlu S. Intramuscular hydatid cyst in the lower extremity: report of three cases. Rev Soc Bras Med Trop. 2021;54:e02552021. 10.1590/0037-8682-0255-2021 . Published 2021 Aug 20. Gougoulias NE, Varitimidis SE, Bargiotas KA, Dovas TN, Karydakis G, Dailiana ZH. Skeletal muscle hydatid cysts presenting as soft tissue masses. Hippokratia. 2010;14(2):126–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4139407","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":285629994,"identity":"80162088-5dae-4797-8bb8-1982fece3cc1","order_by":0,"name":"Hazem Arab","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYHACNmYwxd58AEhKyJCghedYAkgLDwlaJHIMwDoJquefffjZ44KaOjndnjOfX92oseBhYD98dAM+LRLn0syNZxxjMzY73rvNOucY0GE8aWk38FpzhsFMmoeNJ3HbmbPbjHPYgFokeMzwapE/w/5NmuefRP22GznPjHP+EaHF4AyPmTRvm0GC2Y0c5se5bURoMTzDU27M25dguO3MMTPm3D4JoCMJ+EXuDPu2xzzf6uTNjjc//pzzrU6On/3wMfzeRwJsEmCSWOUgwPyBFNWjYBSMglEwcgAAMXJE7X/kAscAAAAASUVORK5CYII=","orcid":"","institution":"Faculty of Medicine, Hama University","correspondingAuthor":true,"prefix":"","firstName":"Hazem","middleName":"","lastName":"Arab","suffix":""},{"id":285629995,"identity":"38658ffd-347f-4f77-9726-8b964c3f69f6","order_by":1,"name":"Yousef Alsaffaf","email":"","orcid":"","institution":"Faculty of Medicine, Hama University","correspondingAuthor":false,"prefix":"","firstName":"Yousef","middleName":"","lastName":"Alsaffaf","suffix":""},{"id":285629996,"identity":"39963a59-3107-485f-9dcc-ace517a3b54b","order_by":2,"name":"Osama Kattan","email":"","orcid":"","institution":"Faculty of Medicine, Hama University","correspondingAuthor":false,"prefix":"","firstName":"Osama","middleName":"","lastName":"Kattan","suffix":""},{"id":285629997,"identity":"e0632c50-6cb5-411d-9d34-67c93af2d9c0","order_by":3,"name":"Saleem Khallouf","email":"","orcid":"","institution":"Hama National Hospital","correspondingAuthor":false,"prefix":"","firstName":"Saleem","middleName":"","lastName":"Khallouf","suffix":""}],"badges":[],"createdAt":"2024-03-20 20:29:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4139407/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4139407/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54038320,"identity":"9f64a184-a752-4b75-bac8-b4b33e806ba3","added_by":"auto","created_at":"2024-04-03 17:14:56","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":284948,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound scan revealed a retroperitoneal hydatid cyst which located below the left kidney with a duplicated and thickened wall measuring (77*110) mm.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4139407/v1/36fdac02574c8fe71f5c5071.jpeg"},{"id":54038322,"identity":"f25cf1f1-9c17-4290-86ec-401892a5808b","added_by":"auto","created_at":"2024-04-03 17:14:56","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":333877,"visible":true,"origin":"","legend":"\u003cp\u003eMulti-slice CT showed 70 mm hydatid cyst in left psoas major muscle extending from L3 to L5, additional (17*39) mm hydatid cyst in left psoas major muscle at L2.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4139407/v1/c2a71dcf0fc9a6eab7c0aba7.jpeg"},{"id":57391162,"identity":"94575145-7911-4287-9f13-5847aeb9c05c","added_by":"auto","created_at":"2024-05-30 05:47:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":944613,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4139407/v1/0c532e76-f5d3-4c56-8742-41a0dea23326.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Two hydatid cysts in the psoas muscle of a 40-year-old female: A rare case report from Syria","fulltext":[{"header":"Background","content":"\u003cp\u003eHydatid disease HD, a zoonotic parasitic infection commonly found in pastoral regions, it can affect any human organ [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The occurrence of muscular HD, particularly affecting the psoas muscle, is considered rare and exceptional even in endemic regions, representing only 1\u0026ndash;3% of cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The development of multiple cysts is an even rarer phenomenon. The clinical presentation of psoas hydatid cysts can vary, making them challenging to diagnosis. Surgery is the mainstay of treatment for psoas hydatid cysts [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this case study, we present a 40-year-old female from a rural area with two hydatid cysts in the psoas muscle.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 40-year-old female from a poverty rural area, presented to the Department of General Surgery with fatigue and abdominal pain without constipation or change in appetite. Physical examination revealed right hypochondrium tenderness. Vital signs were within normal range. The patient had a history of tonsillectomy twenty years ago, cesarean delivery two years ago, and pulmonary hydatid cystectomy seven years ago. The laboratory test was performed and were in normal range (see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Ultrasound showed a retroperitoneal hydatid cyst below the left kidney with a duplicated and thickened wall measuring (77*110) mm (see Fig.\u0026nbsp;1). A multi-slice CT showed a thick-walled, homogenous, low-density hydatid cyst measuring about 70 mm in diameter within the left psoas major muscle, extending beyond the muscle boundaries from the level of the 3rd lumbar vertebra to the 5th lumbar vertebra. An additional cyst was identified within the anterior and lateral portion of the left psoas major muscle at the level of the 2nd lumbar vertebra, measuring approximately (17 * 39) mm (see Fig.\u0026nbsp;2). After consulting urologists, under general anesthesia, a transverse incision was performed on the left pararectal approach with retro-peritoneal passage. Two hydatid cysts were dissected from the psoas major muscle, and cystectomy was performed. The patient was discharged in good condition two days after the operation.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003elaboratory test before surgical operation.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eTest\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eValue\u003c/div\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNormal Range\u003c/div\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eWhite blood cells (10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e6.05\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4.00\u0026ndash;10.00\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLYM (%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e25.6\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e15.0\u0026ndash;50.0\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eGRA (%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e62,8\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e35.0\u0026ndash;80.0\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMID (%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e11.6\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e2.0\u0026ndash;15.0\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eLYM (10\u003csup\u003e3\u003c/sup\u003e\u0026micro;l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1.55\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.5-5.0\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eGRAN (10\u003csup\u003e3\u003c/sup\u003e\u0026micro;l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3.80\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e1.2-8.0\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMID (10\u003csup\u003e3\u003c/sup\u003e\u0026micro;l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.70\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.1\u0026ndash;1.5\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eRed blood cells (10\u003csup\u003e6\u003c/sup\u003e\u0026micro;l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e4.60\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e3.5\u0026ndash;5.5\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eHemoglobin (g/dl)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12.2\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12.0\u0026ndash;16.0\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eHematocrit (%)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e39.3\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e36\u0026ndash;46\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMCV (fl)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e85.4\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e80\u0026ndash;100\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMCH (pg)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e26.4\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e25\u0026ndash;35\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eMCHC (g/dl)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e31.0\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e31.0\u0026ndash;38.0\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003ePlatelet count (10\u003csup\u003e3\u003c/sup\u003e\u0026micro;l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e399\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e150.000-400.000\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eFasting Glucose (mg/dl)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e89\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e70\u0026ndash;110\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eCreatinine (mg/dl)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.7\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e0.6\u0026ndash;1.2\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eALT (U/l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e19\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10\u0026ndash;60\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAST (U/l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e10\u0026ndash;50\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eAmylase (U/l)\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e130\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003e30\u0026ndash;300\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eHBsAg\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eNegative\u003c/div\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cdiv class=\"SimplePara\"\u003eN/A\u003c/div\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eMCH: Mean corpuscular hemoglobin, MCV: Mean corpuscular volume, MCHC: Mean corpuscular hemoglobin, ALT: Alanine transaminase, AST: Aspartate transaminase.\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHydatid disease, also known as hydatidosis, is a zoonotic condition caused by the development of the larval form of canine tenia (Echinococcus granulosus) in the host\u0026rsquo;s organism. The definitive host of this tenia is dog, whereas the development in human is accidental by consumption of parasitized viscera, particularly the liver and lungs of the intermediate host (sheep) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Echinococcus granulosus is the most common causative agent, while Echinococcus alveolaris is rare [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] It is endemic and constitutes a real public health problem in regions such as the Mediterranean, Middle East, South America, New Zealand, and Australia, predominantly affecting rural and poor populations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While primary cysts can occur anywhere in the body, they are most frequently found in the liver (55\u0026ndash;70%) and lungs (20\u0026ndash;30%), with muscular tissue involvement accounting for only 2\u0026ndash;3% of cases [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The muscular HD is a rare affection and the effect of the psoas seems exceptional; even in country of endemic disease. The efficient filtration mechanisms of the liver and lungs make it challenging for echinococcal larvae to reach musculoskeletal tissues. Additionally, the high lactic acid content and mechanical factors in muscles deter parasite growth [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Psoas muscle hydatid cysts typically manifest during childhood and young adulthood as painless muscle masses. Clinical symptoms can vary from nonspecific complaints to severe complications like anaphylaxis and death. Complications of psoas muscle hydatid cysts may include superinfection, nerve injuries, ureteral compression, and other serious consequences [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Imaging plays a crucial role in diagnosing and assessing hydatid disease. Ultrasound is often the initial diagnostic tool with a high reliability rate of 96%, The ultrasound appearance reproduces the stages of Gharbi\u0026rsquo;s classification and the stage of the disease. While CT scan is essential for deep-seated cysts such as those in the psoas muscle [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Magnetic resonance imaging (MRI) may be utilized in cases where diagnosis remains uncertain [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Biological testing aids in confirming the diagnosis particularly in challenging cases, and monitoring treatment progress. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The choice of treatment modalities depends on the cyst\u0026rsquo;s anatomical location, its relation to major anatomical structures, the number of cysts, the patient\u0026rsquo;s general health status, and the surgeon\u0026rsquo;s experience. If a preoperative diagnosis of hydatid cyst is made, the best therapeutic option should be surgery, although percutaneous treatment may have a role. For cysts localized in the psoas muscle, the lumbar extraperitoneal approach is the safest access in order to avoid peritoneal dissemination. The greatest danger for the patient (especially if hydatid disease is not suspected preoperatively) is dissemination with possible secondary implant and anaphylactic reaction. It is obvious that every measure must be taken to avoid dissemination of the disease [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The use of supplementary chemotherapy with anti-helminthic drugs for skeletal muscle hydatid disease remains controversial, lacking evidence-based recommendations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In this particular case, we describe a rare occurrence of a 40-year-old female from a rural area presenting with two hydatid cysts in the psoas muscle.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the rare occurrence of hydatid cysts within the psoas major muscle of a middle-aged female from a rural background, Early recognition, accurate radiological assessment, and appropriate surgical intervention are pivotal in achieving favorable outcomes and preventing potential complications associated with hydatid cysts, such as infection, compression of adjacent structures, or anaphylactic reactions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe materials used during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.A. collected the patient\u0026rsquo;s data and writing \u0026ndash; original draft. Y.A. collected the patient\u0026rsquo;s data and writing \u0026ndash; original draft. O.K. collected the patient\u0026rsquo;s data and writing \u0026ndash; original draft. S.K. collected the patient\u0026rsquo;s data, revised the manuscript, performed the procedure, and supervised the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJia Q, Wu S, Guo J et al. Giant muscle hydatid in lower extremity: a rare case with neurological symptoms as the first manifestation. BMC Infect Dis. 2023;23(1):645. Published 2023 Oct 2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12879-023-08616-y\u003c/span\u003e\u003cspan address=\"10.1186/s12879-023-08616-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMerad Y, Derrar H, Zeggai A, Belkacemi M, Belmokhtar Z, Adjmi-Hamoudi H. A rare primary hydatid cyst of the psoas muscle in a rural setting: A case presentation. Ann Med Surg (Lond). 2020;59:86\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amsu.2020.09.002\u003c/span\u003e\u003cspan address=\"10.1016/j.amsu.2020.09.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2020 Sep 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMhand M, Ramdani A, Khomssi N, et al. Hydatid cyst of the psoas: case report and review of literature. Ann Med Surg (Lond). 2023;85(3):424\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MS9.0000000000000087\u003c/span\u003e\u003cspan address=\"10.1097/MS9.0000000000000087\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2023 Mar 9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWani I, Wani RA, Alam Wani K. Primary hydatid of psoas muscle. Urol Ann. 2010;2(2):89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0974-7796.65112\u003c/span\u003e\u003cspan address=\"10.4103/0974-7796.65112\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Khassoui A, Aghoutane EM, Salama T, El Fezzazi R. Psoas Hydatid Cyst in Children: A Rare Localization about a Case. Case Rep Pediatr. 2021;2021:1961509. Published 2021 Nov 6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1155/2021/1961509\u003c/span\u003e\u003cspan address=\"10.1155/2021/1961509\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŞimşek S, Hattapoğlu S. Intramuscular hydatid cyst in the lower extremity: report of three cases. Rev Soc Bras Med Trop. 2021;54:e02552021. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/0037-8682-0255-2021\u003c/span\u003e\u003cspan address=\"10.1590/0037-8682-0255-2021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2021 Aug 20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGougoulias NE, Varitimidis SE, Bargiotas KA, Dovas TN, Karydakis G, Dailiana ZH. Skeletal muscle hydatid cysts presenting as soft tissue masses. Hippokratia. 2010;14(2):126\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hydatid disease, Psoas muscle, Right hypochondrium tenderness, retroperitoneal hydatid cyst, Hydatidosis, Echinococcus granulosus, Case report","lastPublishedDoi":"10.21203/rs.3.rs-4139407/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4139407/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHydatid disease, a zoonotic infection common in pastoral areas, can affect any human organ. Muscular involvement, especially in the psoas muscle, is rare, comprising only 1-3% of cases, even in endemic regions. The presence of multiple cysts is even rarer. Clinical presentation varies, making them challenging to diagnostic. Surgical intervention is the primary treatment for psoas hydatid cysts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 40-year-old female from a rural area presented with fatigue and abdominal pain, without constipation or changes in appetite. Physical examination revealed tenderness in the right hypochondrium. Her medical history included tonsillectomy twenty years ago, cesarean delivery two years ago, and pulmonary hydatid cystectomy seven years ago. Ultrasound detected a retroperitoneal hydatid cyst, while a multi-slice CT scan showed a hydatid cyst within the left psoas major muscle and an additional cyst in the anterior and lateral portions of the left psoas major muscle. Surgeries successfully removed two cysts from the left psoas major muscle, and the patient was discharged in good condition two days post-surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights the rarity of psoas major muscle hydatid cysts in a middle-aged woman from a rural area. Early recognition, accurate radiological assessment, and proper surgical treatment are crucial for positive outcomes and averting complications like infection, compression of nearby structures, or anaphylactic reactions.\u003c/p\u003e","manuscriptTitle":"Two hydatid cysts in the psoas muscle of a 40-year-old female: A rare case report from Syria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-03 17:14:51","doi":"10.21203/rs.3.rs-4139407/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ec09232b-d987-4140-97e9-e836011b650c","owner":[],"postedDate":"April 3rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-30T05:39:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-03 17:14:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4139407","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4139407","identity":"rs-4139407","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}