Isolated costal echinococcosis: management and prognostic outcomes

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Echinococcosis is a widespread infectious condition. When the disease affects the thoracic wall, specifically the ribs, it presents significant diagnostic, therapeutic, and prognostic challenges. Methods: It's a retrospective, multicenter study covering cases recorded between 2000 and 2024. Results: We collected 12patients (9Men/3women) with a mean age of 41 years. Five patients had a prior history of echinococcosis of the lungs or liver. Costal hydatidosis was discovered by a parietal swelling (n=5), rib pain (n=2) or fortuitously (n=5). Chest X-rays detected a parietal opacity in 8 cases, pleural effusion in 2 cases, and cortical rib irregularities in 2 cases. Thoracic ultrasound showed an anechoic parietal mass in 2 cases and a multivesicular pattern in 6 cases. CT scans revealed poorly defined hypodense lacunar lesions (n=3), multivesicular formations (n=7), and costal bone destruction (n=10). More than two ribs were affected in 6 patients. MRI depicted a lesion with hypointense T1 and hyperintense T2 signals. Hydatid serology was positive in 6 cases. All patients were operated via a posterolateral thoracotomy. Costal resection was performed in 7 cases. Postoperative course was uneventful in 10 cases. One patient presented wound infection and another presented an acute respiratory distress syndrome. Albendazole therapy was administered to all patients. During the follow-up, recurrence was observed in 2 patients. Unfortunately, 3 patients succumbed to complications related to hydatid disease. Conclusion: In the costal echinococcosis, the prognosis depends on associated vertebral involvement and recurrences that's why it should be considered similar to a malignant lesion.

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