A 3-year-old girl was brought to paediatric outpatient department of our tertiary medical centre by her mother with complaints of painless swelling in right subcostal region. There was no history of fever, trauma at the time of presentation and the child was otherwise normal for its age.
High-resolution ultrasound of the lesion revealed a well-defined ellipsoidal lesion (size~ 16.5x7.6 mm) with a cystic component and an eccentric echogenic nodule (Fig. 1 a, b) within it, suggestive of scolex in the muscular planes of the anterior abdominal wall in the right subcostal region. Hence, a diagnosis of isolated abdominal wall cysticercosis was made based on high-resolution ultrasound findings.
Taenia solium infection is considered endemic in countries like South Asia, Brazil and Korea due to improper hygiene in rural areas [1]. Humans are the only definitive hosts while both humans and pigs can act as intermediate hosts. Feco-oral transmission is considered the most common mode of transmission. Humans often are infected by ingesting undercooked or raw pork, water or vegetables containing cysticerci larvae. The central nervous system is strongly affected by the parasite, however, involvement of soft tissues, orbit and muscles are less frequently seen. The subcutaneous and intramuscular cysticercosis usually presents as multiple, mobile, firm subcutaneous nodules with its predisposition to involve upper and lower limbs. They are often asymptomatic and about 1x2 cm in size. However, 20% of the cases may be painful and can lead to abscess formation [2]. Isolated soft tissue and muscular cysticercal involvement, per se, is very rare and clinically mimics the diagnosis of intramuscular tumours like lipoma, neuroma, neurofibroma, tubercular lymphadenitis and soft tissue myxomas. It is considered a diagnostic challenge if it presents as an isolated cysticercal lesion as in our case, due to lack of specific clinical features.
Serological examination may add to the diagnosis of cysticercosis. Enzyme-linked Immunoblot assay is more than 98% specific and sensitive in its diagnosis. But in cases of isolated subcutaneous and intramuscular cysticercal lesion, even the sensitivity of Enzyme-linked Immunoblot assay drops to 60 to 80% [3, 4]. Therefore high-resolution ultrasound is considered to play a key role in accurate diagnosis of isolated subcutaneous and intramuscular cysticercal lesions due to its peculiar ultrasound findings.
Other radiological modalities like MRI may also sometimes reveal the scolex in cases of solitary cysticercosis. CT may add to the diagnosis by depicting any calcification within it, if any. Scolices are more easily detected on ultrasound than MR imaging [5]. However, high-resolution ultrasound is still preferred because of its easy availability, cost effectiveness and ability to help making an early diagnosis.
Cestocidal agents like Albendazole or Praziquental may be used as an initial conservative treatment modality. Steriods can also be added to the treatment regimen in order to avoid some adverse reactions. It usually takes few weeks to months for a complete resolution of the lesion. However, surgical excision is considered the definitive treatment in cases of symptomatic patients and for cosmetic purposes.
Isolated abdominal wall cysticercosis
Based on the provided ultrasound images (Figure 1A, Figure 1B) and the patient’s clinical information (a 3-year-old girl with a painless mass under the right costal margin), there is a round or oval hypoechoic area of about 1–2 cm within the subcutaneous/muscle layer. Within this area, a hyperechoic spot can be observed, suggesting the presence of a parasitic scolex. The surrounding soft tissue echogenicity appears acceptable, with no obvious enhancement or significant infiltrative changes, and no evidence of bony destruction or apparent calcification.
Based on the imaging findings and the patient’s medical history, the following differential diagnoses should be considered:
Taking into consideration the patient’s age, the painless soft tissue mass under the right costal margin, and the ultrasound images demonstrating a clearly visible cystic lesion with a suspected scolex, the most likely diagnosis is:
Muscular or Soft Tissue Cysticercosis (Cysticercosis).
For definitive confirmation, additional laboratory tests (serological or enzyme-linked immunoelectrotransfer blot) and histopathological examination (biopsy of the lesion) can be conducted to exclude other differential diagnoses.
Treatment Options:
FITT-VP Principle for Rehabilitation/Exercise Prescription:
Because the patient is only 3 years old, the exercise regimen should primarily focus on daily activities and play, ensuring safety and enjoyment. Given that the lesion is located in the soft tissue, it typically does not restrict basic activities. However, a gradual approach is advised:
If surgical treatment is performed or the lesion becomes symptomatic, activity should be gradually reintroduced once the incision has healed or inflammation has subsided. Further specific rehabilitation can be guided by pediatric rehabilitation specialists or physical therapists as needed.
This report is a reference analysis based on the available information and does not replace in-person consultation or professional medical advice. If further symptoms develop or concerns arise, please seek timely medical attention and specialized care.
Isolated abdominal wall cysticercosis
