Orthopaedic aspects of osseous echinococcosis

Purpose: 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. granu losus, we intend to emphasize current standards in surgical and drug manage ment of the disease. Typical radiographic and blood-chemistry findings are highlighted on a 62-year-old Arabiqu female suffering from a cystic echinoc occosis with skeletal manifestation in the left ileum and lower lumbar spin e. Results: Radiographically typical are fine zones of osteolysis which, at a later stage, show confluence. Due to the rigid structure of cortical bon e, cysts tend to grow slowly, and seldom exceed 2cm 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. Furthe rmore, serological tests can be used as a screening method, offering a diag nostic tool that can also utilized in detecting a recurrence. Conclusion: T he surgical aim in the treatment of osseous echinococcosis should be in acc ordance to curative tumor surgery. Even after radical removal of the parasi tes, the WHO suggests an adjuvant chemotherapy with mebendazole or albendaz ole for at least two years after surgery. In cases where only a palliative treatment is possible, the antihelminthic drug administration can be contin uous.