Primary isolated thoracic vertebral hydatid disease with multicompartment extension: A case report

Vertebral hydatid disease is a rare manifestation of cystic echinococcosis, accounting for less than 1% of all cases, while primary isolated vertebral involvement is exceptionally uncommon. We report the case of a 33-year-old woman presenting with progressive spastic paraplegia. Magnetic resonance imaging revealed a multilobulated left thoracic costovertebral lesion centered at the T6-T7 level, composed of multicystic and enhancing solid components. The lesion involved the T6 and T7 vertebral bodies and posterior elements, with extensive intraspinal, pleural, and paravertebral soft-tissue extension. Multiple daughter cysts within the paravertebral soft tissues strongly suggested hydatid disease. No intramedullary signal abnormality was observed despite marked spinal cord compression. Thoracic computed tomography and abdominal ultrasonography showed no evidence of visceral hydatid disease. Histopathological examination of a computed tomography-guided biopsy confirmed the diagnosis of primary isolated thoracic vertebral hydatid disease. The patient was started on albendazole therapy and scheduled for surgical decompression. This case highlights the pivotal role of magnetic resonance imaging in demonstrating the characteristic imaging features and accurately delineating the full extent of disease. In endemic regions, hydatid disease should be considered in the differential diagnosis of destructive multicystic vertebral lesions with intraspinal extension, allowing timely multidisciplinary management and improved neurological outcomes.