A 53-year-old woman presented to our hospital with a three-month history of painful mass growing on the left lateral side of the neck. She reported neither fever nor a weight loss. Upon physical examination, some hard, painful, and fluctuant mass of 10 x 7 cm was palpable on the supraclavicular region of the lateral neck. The overlying skin was inflammatory. We did not find any regional lymphadenopathy. The blood cell count was normal except an increased erythrocyte sedimentation rate (ESR 40 mm/h). No abnormality was found in chest X-ray.
CT scan demonstrated a binocular mass on the left supraclavicular region with cystic aspect. Its dimensions are 14 x 10 cm, and it contains numerous cystic formations with thin outlines (Figure 1). From this clinical and radiographic signs, the patient was diagnosed as having pyogenic abscess or tuberculosis, and its excision or drainage was planned. The diagnosis of Echinococcus granulosus infection was confirmed perioperatively after visualization of the cyst wall and daughter cysts (Figures 2 and 3). Following irrigation of cystic cavity with hypertonic saline solution, the cyst wall was excised with a portion of overlying skin and muscle (Figure 4). Histopathological examination of the specimen revealed hydatid cyst and showed an inflammatory tissue reaction surrounding "parasite-like cyst." Scoleces were also detected within the surgical specimen. The patient was subjected to ultrasound of the abdomen and urologic examination. Hemagglutination tests for Echinococcus and ELISA were negative. The investigation did not reveal any extracervical sites for other hydatid cyst. The patient received Albendazole (400 mg/day) for eight weeks postoperatively. No sign of recurrence could be detected by physical examination and imaging at the 4-month followup.