Chilaiditi's syndrome presenting as unexplained tender hepatomegaly.

Sir, Only a few cases of hydatid cyst occurring in the neck area have been reported the biggest series being 9 cases reported by Touhami et al.' This prompted us to report a further case. A 25 year old male presented with a swelling on the left side of the lower neck, gradually progressive in size for one year. The swelling was 10 x 8 cm, situated partially under the left lower part of the sternocledomastoid and was soft in consistency. Oral and ear, nose and throat examination were normal. Fine needle aspiration was carried out which revealed clear fluid and the cytology report was inconclusive. The cyst was excised and the histopathology confirmed it to be echinococcal disease. During follow-up the patient was evaluated for any other site of hydatid, but radiology of chest and ultrasonography of liver, spleen and kidney were normal. Hydatid cyst develops most commonly in liver (60%), lungs (20%) and rarely in brain, eye, heart, bone or other internal organs.2 The disease presents as a slow growing benign tumour with pressure symptoms according to its site of occurrence. Immunoelectrophoresis is a highly specific test for diagnosis. In the neck area it is very difficult to diagnose hydatid cyst. Even fine needle aspiration cytology is inconclusive unless one submits it for microscopic examination with a high suspicion index. In endemic areas, one should keep in mind the possibility of hydatid cyst when presented with a cystic lump in the neck.