hydatid disease or hydatidosis , caused by echinococcus granulosus , is the most widespread , serious human cestode infection in the world . the liver and the lungs are most frequently involved , and hydatid cysts of other organs are unusual . bone involvement is reported in 0.5 - 4% of the cases , and 50% of those are seen in the spine . therefore , vertebral hydatidosis is uncommon ; however , in endemic areas , physicians should be vigilant in case of relevant patients with mild symptoms , in whom the clinical scenario may well masquerade as other common low - back problems . we present a rare case of primary thoraco - lumbar extradural hydatid cyst presenting as large swelling mimicking lipoma with meralgia paresthetica like syndrome . a 45-year - old female presented with swelling in the thoraco - lumbar region which had been present for last 1 year but had enlarged rapidly over the last 3 months . apart from its size , it did not give any problem except that since the last few weeks she had started experiencing tingling sensation over her anterior - lateral aspect of left thigh and slight weakness in her left lower limb resulting into a limp . she was otherwise in good health except for mild hypertension for which she took no medication . . local examination , revealed a large swelling , of size 30  25  25 cm in the thoraco - lumbar region which was soft , lobulated and non tender . neurological examination did not reveal any significant finding except for sensory loss over the antero - lateral aspect of left thigh and grade 3 power in the flexors of left hip joint . local usg of swelling was suggestive of hydatid cyst in subcutaneous tissue with membranes , septations and daughter cysts within the cystic cavity . x - ray lumbo - sacral spine anteroposterior ( ap ) view was suggestive of destruction of spinous process and left pedicle of l1-l2 vertebrae [ figure 2 ] . further magnetic resonance imaging ( mri ) of thoraco - lumbar spine was planned which revealed a well defined lesion with daughter cyst involving subcutaneous tissue of back , paraspinal muscle , post neural arch segment of d12-l2 with extradural extension into spinal canal at d12-l2 level [ figure 3 ] . large swelling of size 30 cm  25 cm  25 cm in the thoraco - lumbar region x - ray lumbo - sacral spine ap view showing destruction of spinous process and left pedicle of l1-l2 vertebrae mri of spine showing a well - defi ned lesion with daughter cyst involving subcutaneous tissue of back , paraspinal muscle , post neural arch segment of d12-l2 with extradural extension into spinal canal at d12-l2 level the patient underwent t12 to l2 laminectomy with total cyst excision with membrane . the operative field was soaked with hydrogen peroxide wetted patties for a few minutes and then washed with normal saline . there was no further weakness and tingling sensation over the lower extremity after 1 month of treatment . also , there was no recurrence during the follow - up period of two years . h and e , stained slide ( 10 ) view shows proteinaceous laminated membrane and necrotic , calcifi ed osseous tissue echinococcosis is a widespread disease that appears during the evolution of the parasite echinococcus granulosus . primary vertebral hydatid disease without any other systemic involvement can occur with direct porto - vertebral venous shunts . generally , spinal hydatid cyst disease present with radicular symptom or symptom of cord compression . proximal lesions such as lumbar radiculopathy , lumbar disc herniation , and spinal stenosis have been reported to cause meralgia paresthetica - like syndrome . these proximal lesions directly injure the respective spinal nerve roots and cause a constant compression of the nerve roots . for this reason it is often misdiagnosed initially as tuberculosis of the spine , spinal tumor or disc herniation . computed tomography , magnetic resonance imaging ( mri ) and ultrasonography ( usg ) with their recent advances have become a very sensitive diagnostic tool . usg shows the membranes , septations , and daughter cysts within the cystic cavity while mri helps in localization as well as to note the extent of cord compression . however , due to the invasive nature of infestation in the spine , total removal to achieve complete eradication becomes a needful . overall , a recurrence rate of 30 - 40% is described and there is a correlation between cyst localization and recurrence . to prevent recurrence mebendazole and albendazole with their established lethal effect on secondary e. granulosus cyst can be used in the pre- , peri- and post - operative periods . primary hydatid cyst disease of the skeletal muscle must be considered among the differential diagnosis of atypical vertebral lesion although spinal hydatidosis without other organ involvement is uncommon . when a cystic lesion is found on radiological evaluation , total excision of cyst with an intact wall is best treatment followed by albendazole for minimum of 3 weeks .
meralgia paresthetica presents as tingling sensation in the antero - lateral aspect of thigh . 
 it occurs due to compression of the lateral cutaneous nerve of thigh . 
 proximal spinal lesions may present as meralgia paresthetica due to radiculopathy . 
 we present a rare case of spinal hydatid with meralgia paresthetica .