A 59-year-old man presented with a history of high blood pressure, tuberculous epididymitis correctly treated 4 years previously, and an episode of primary pulmonary haemorrhage 5 months earlier. He reported a 2 month history of dysuria with a 3–4 mm white urinary sediment composed of “grape skin”-like deposits. He denied fever. The physical examination, blood test (including eosinophils), biochemistry, urine sediment, and chest and abdominal x rays were all normal.

A pelvic and abdominal ultrasound showed a retrovesical mass adhering to the gallbladder wall, with heterogeneous echogenicity and multiple cystic areas.

The abdominal computed tomography (CT) scan (fig 1) showed a 12.5×13×10 cm calcified cystic lesion between the rectum and the bladder.

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Figure 1

Cystic lesion between the rectum and the bladder.

Urine cytology (fig 2) was compatible with a scolex. Serology (indirect haemagglutination) was positive with a titre 1/3200.

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Figure 2

Urine cytology: hooks of a scolex.

Laparotomy showed a large extraperitoneal retrovesical tumour adhering to the rectum and the ureter. The cyst was excised after aspiration of its contents and an injection of 33% hypersonic saline, and the damaged bladder area was reconstructed. The diagnosis was confirmed as a hydatid cyst. Three months later the patient had no symptoms but continued taking albendazole 800 mg/day, which he was also taking 1 month before surgery to decrease the size of the cyst.1^–6 After the surgery the patient has progressed well and at the moment is asymptomatic.

Retrovesical hydatidosis is a rare condition (0.1–0.5%) that must nevertheless be considered in the differential diagnosis in patients with these symptoms who live in endemic areas.