Echinococcal Cysts in the Leg
A 35-year-old man presented to the outpatient clinic with a 6-month history of progressive swelling of his right lower leg. The physical examination was notable for firm swelling in the right lower leg without any warmth or tenderness on palpation (Panel A). Magnetic resonance imaging of the right lower leg revealed a well-defined cystic lesion, measuring approximately 19.2 cm by 12.4 cm by 9.8 cm, with multiple daughter cysts and floating membranes (Panels B and C). Computed tomography of the thorax and abdomen showed no cysts. The appearance was consistent with echinococcal cysts, and an enzyme-linked immunosorbent assay for the detection of antibodies to echinococcus was positive. Cystic echinococcosis, also called hydatid disease, is caused by the echinococcus tapeworm. The patient was treated with albendazole for 7 days before undergoing pericystectomy. Infection with Echinococcus granulosus was confirmed. The patient had an uneventful postoperative course and received albendazole for an additional 3 weeks after surgery. At a follow-up visit after the completion of treatment, he had no signs or symptoms of recurrence.