Hydatid Disease

This rare disease results from the lodgment of the embryos of the tænia echinoccus, which are conveyed to the marrow by the blood-stream. The cysts are small, usually about the size of a pin-head, and they are present in enormous numbers scattered throughout the marrow. The parts of the skeleton most often affected are the articular ends of the long bones, the bodies of the vertebræ, and the pelvis.

As the cysts increase in number and in size, the framework of the bone is gradually absorbed, and there result excavations or cavities. The marrow and spongy bone first disappear, the compact tissue then becomes thin, and pathological fracture may result. The bone becomes expanded, and the cysts may escape through perforations into the surrounding cellular tissue, and when thus freed from confinement may attain considerable dimensions. Suppuration from superadded pyogenic infection may be attended with extensive necrosis, and lead to disorganisation of the adjacent joint.

Clinical Features.—The patient complains of deep-seated pains. In superficial bones, such as the tibia, there is enlargement, and it may be possible to recognise egg-shell crackling, or unequal consistence of the bone, which is hard in some parts, and doughy and elastic in others. The disease may pursue an indolent course during months or years until some complication occurs, such as suppuration or fracture. With the occurrence of suppuration the disease becomes more active, and abscesses may form in the soft parts and in the adjacent joint. In the vertebral column, hydatids give rise to angular deformity and paraplegia. In the pelvis, there is usually great enlargement of the bones, and when suppuration occurs it is apt to infect the hip-joint and to terminate fatally.

Examination with the X-rays shows the characteristic excavations of the bone caused by the cysts. The disease is liable to be mistaken for central tumour, gumma, tuberculosis, or abscess of bone.

The treatment consists in thorough eradication of the parasite by operation. The bone is laid open and scraped or resected according to the extent of the disease, and the raw surfaces swabbed with 1 per cent. formalin. In advanced cases complicated with spontaneous fracture or with suppuration, amputation affords the best chance of recovery.

The lesions in the bones resulting from actinomycosis and from mycetoma, have been described with these diseases.