Diagnostic challenges and treatment approaches for hydatid cysts in atypical localizations

Table 1 Diagnostic and therapeutic strategy for rare forms of echinococcosis

Localization	Preferred imaging	Surgical considerations	Medical therapy	Special notes
Brain/CNS	MRI	Craniotomy with cyst excision	Albendazole perioperatively	High risk of rupture; pre-op imaging critical
Bone/spine	CT/MRI	En bloc resection ± stabilization	Long-term albendazole	Often mimics tumors; recurrence risk high
Kidneys	CT/US	Partial/total nephrectomy	Albendazole + scolicidal agents	Differentiate from neoplasms
Thyroid/neck	MRI/US	Organ-preserving resection if feasible	Short course albendazole	Careful dissection to avoid dissemination. FNAB is also appropriate
Breast	US, MRI	Pericystectomy	Albendazole pre- and postoperatively	Rare; can mimic malignancy. Diagnosis requires high index of suspicion.
Retroperitoneum	CT/MRI	Surgical excision where accessible	Albendazole pre- and postoperatively	Risk of incomplete resection
Soft tissues/muscle	MRI	Complete cyst removal	Adjunctive therapy recommended	Often misdiagnosed as sarcoma or abscess
Pelvic organs	MRI	Organ-sparing surgery if possible	Albendazole + scolicidal agents	May mimic gynecologic tumors

CNS: Central nervous system; MRI: Magnetic resonance imaging; CT: Computed tomography; US: Ultrasound.