Egyptian Journal of Ear, Nose, Throat and Allied Sciences (2016) 17, 103–105

H O S T E D BY
Egyptian Society of Ear, Nose, Throat and Allied Sciences

Egyptian Journal of Ear, Nose, Throat and Allied

Sciences
www.ejentas.com

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 Abstract Echinococcosis or hydatid disease is a zoonotic infection caused by Echinococcus

Hydatid disease; granulosus. It has been recognized by humans for centuries, as it was described by Hippocrates more
Neck; than two thousand years as a ‘‘fluid-filled liver”, and the famous Arabian physician Al-Rahzes
Surgery 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.
Ó 2016 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 by humans for centuries, as it was described by Hippocrates

more than two thousand years as a ‘‘fluid-filled liver”, and
Echinococcosis or hydatid disease is a zoonotic infection the famous Arabian physician Al-Rahzes described it, but it
caused by Echinococcus granulosus.1 It has been recognized took till the 17th century when Francesco Redi illustrated that
the hydatid cysts of echinococcosis were of animal origin.2
* Corresponding author at: Hamad Medical Corporation, P.O. BOX Hydatid disease is endemic in the Middle East, India, Africa,
3050, Qatar. Tel.: +974 55063872. South America, New Zealand, Australia, Turkey and Southern
E-mail addresses: [email protected] (R. Khalifa), fnasser@ Europe3,4 keeping in mind that it can occur also in non-
hamad.qa (F. Nasser), [email protected] (A. Elsetouhy), ifarag@ endemic countries because of the upsurge of emigration and
hamad.qa (I. Farag).
trade.5 The primary hosts are dogs. Intermediate hosts are
Peer review under responsibility of Egyptian Society of Ear, Nose,
sheep, cattle, horses and occasionally man.1
Throat and Allied Sciences.
http://dx.doi.org/10.1016/j.ejenta.2016.01.002
2090-0740 Ó 2016 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/).
104 R. Khalifa et al.

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, Figure 3 Coronal post contrast CT images of the neck showing
State of Qatar, with a chief complaint of a right neck swelling, the cystic lesion deep to the right angle of the mandible displacing
noted about 6 month back. The general condition of the the right submandibular gland superomedially.

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
Figure 1 3D demonstration of the right upper neck mass. 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
Figure 2 Axial Post contrast CT neck showing a well-defined neck region even in geographical areas where echinococcal
cystic lesion medial to the right angle of mandible showing infestation is frequent, and only few cases have been reported
enhancing wall of uniform thickness. in the literature.6,7 Hydatid cysts are usually not considered in
Hydatid cyst of the neck 105

the differential diagnosis of head and neck cystic swellings, 2. Jump up Connolly, Stephanie. Echinococcosis. 2006. Web. 5
especially in non-endemic areas in the absence of hydatid February 2010. <http://www.stanford.edu/group/parasites/Para-
disease elsewhere in the body. The rarity of the disease in this Sites2006/Echinococcus/index.html>.
anatomical location presents a diagnostic difficulty for the 3. Jastaniah S, Malatani TS, Abu-Eshy S, et al. Hydatid cyst disease
(Echinococcus granulosus): experience at Asir Central Hospital.
physician if he or she is not familiar with the disease.9
Saudi J Gastroenterol. 1997;3:140–143.
If the cysts ruptured while in the body, whether during sur- 4. Abu-Eshy S, Elamin Ali M. Hydatid cyst associated with
gical extraction or by some kind of trauma to the body, the pregnancy: a case report and review of the literature. Ann Saudi
patient would most likely go into anaphylactic shock.12 This Med. 1999;19:130–131.
event didn’t occur in the patient included in the study. 5. Kehila M, Allegue M, Abdessalem M, Letaief R, Said R,
Standard treatment modality is surgical removal of the Khalfallah A. Hydatic cyst of the psoas: one case. J Radiol.
cysts combined with chemotherapy using albendazole and/or 1987;68:
mebendazole before and after surgery, albendazole is preferred 265–268.
twice a day for 1–5 months.13 6. Aleksic-Shihabi A, Vidolin EP. Cystic echinococcosis of the heart
and brain: a case report. Acta Med Okayama. 2008;6:341–344.
7. Katilmis H, Ozturkcan S, Ozdemir I, Adadan Guvenc I, Ozturan
4. Conclusion S. Primary hydatid cyst of the neck. Am J Otolaryngol.
2007;28:205–207. http://dx.doi.org/10.1016/j.amjoto.2006.08.007.
When dealing with well-defined cystic lesions in the head and 8. Aletras H, Symbas N. Hydatid disease of the lung. In: Shields TW,
neck area hydatid cyst should be considered in the differential LoCicero J, Ponn RB, eds. General Thoracic Surgery. Philadel-
diagnosis even in non-endemic areas due to the high emigra- phia: Lippincott Williams and Wilkins; 2000:1113–1122.
9. Cangiotti L, Muiesan P, Begni A, et al. Unusual localizations of
tion rates. Care should be taken by the operating team during
hydatid disease: a 18 year experience. G Chir. 1994;15:83–86.
surgery as ruptured cyst may cause anaphylactic shock.
10. Pandolfo I, Blandino G, Scribano E, Longo M, Certo A, Chirico
This case report is granted for publication with reference: G. CT findings in hepatic involvement by Echinococcus granulosus.
MRC/1367/2015. J Comput Assist Tomogr. 1984;8(5):839–845.
11. Al Ani A, Elzouki A, Mazhar R, An imported case of
Conflict of interest Echinococcosis in a pregnant lady with unusual presentation.
Department of Medicine, Hamad General Hospital, Hamad
Medical Corporation, Doha, Qatar Case, Reports in Infectious
None declared.
Diseases, vol. 2013 (2013), Article ID 753848, p. 4.
12. Bitton M et al. Anaphylactic shock after traumatic rupture of a
References splenic echinococcal cyst. Harefuah. 1992;122(4):226–228.
13. Eckert J, Deplazes P. Biological, epidemiological, and clinical
1. Akal M, Kara M. Primary hydatid cyst of the posterior cervical aspects of echinococcosis, a zoonosis of increasing concern. Clin
triangle. J Laryngol Otol. 2002;116:153–155. Microbiol Rev. 2004;17(1):107–135. http://dx.doi.org/10.1128/
cmr.17.1.107-135.2004, PMC 321468. PMID 14726458.