[Orthopedic aspects of osseous echinococcosis--radiologic diagnosis, current surgery and drug therapy aspects].
OBJECTIVE
Skeletal manifestation of alveolar (E. multilocularis) or cystic (E. granulosus) echinococcosis is seldom, with an incidence of less than 2% of all cases. By reporting on a rare case of bony manifestation of E. granulosus, we intend to emphasize current standards in surgical and drug management of the disease. Typical radiographic and blood-chemistry findings are highlighted on a 62-year-old Arabiqu female suffering from a cystic echinococcosis with skeletal manifestation in the left ileum and lower lumbar spine.


RESULTS
Radiographically typical are fine zones of osteolysis which, at a later stage, show confluence. Due to the rigid structure of cortical bone, cysts tend to grow slowly, and seldom exceed 2 cm in diameter. Only after having broken through the cortical bone, may a massive increase in size be observed. By means of serological tests, it is postoperatively possible to evaluate how successful radical surgery with removal of larvae was. Furthermore, serological tests can be used as a screening method, offering a diagnostic tool that can also utilized in detecting a recurrence.


CONCLUSIONS
The surgical aim in the treatment of osseous echinococcosis should be in accordance to curative tumor surgery. Even after radical removal of the parasites, the WHO suggests an adjuvant chemotherapy with mebendazole or albendazole for at least two years after surgery. In cases where only a palliative treatment is possible, the antihelminthic drug administration can be continuous.
Diedrich
O
O
Klinik und Poliklinik für Orthopädie der Rheinischen Friedrich-Wilhelms-Universität Bonn. Diagnostik@drdiedrich.de
Kraft
C N
CN
Zhou
H
H
Sommer
T
T
Perlick
L
L
Schmitt
O
O
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D015766:Albendazole / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip; D003131:Combined Modality Therapy; D004443:Echinococcosis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008463:Mebendazole / Q000008:administration & dosage; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000601:surgery; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*
D008463:Mebendazole; D015766:Albendazole