Human cystic echinococcosis, caused by the metacestodes of E. granulosus, has been occasionally reported from archeological sites worldwide (9). By looking at this zoonotic helminthes life cycle (3), hydatid cyst might have circulated on the Earth since the Homo sapiens time, and its occurrence may have increased significantly since the Neolithic revolution. Supporting the claim can be justified in occasional contacts between humans and canines in pre domestication periods.

Despite expecting a higher number of hydatidosis in ancient times, the scarcity of these findings in archeological sites can be undoubtedly attributed to neglect in collecting the biological samples besides the similarities of calcified hydatid cysts to pebbles obtained in ancient cemeteries (10). Nevertheless, mentioning the number of cystic echinococcosis confirmed in the brain and lung of the Egyptian mummies by tissue sections is an impressive example (11). To avoid any neglect in exceptional opportunities during the archeological excavations, archeologists should be more cautious in dealing with possible biological remains in the burials and those near the skeletons in excavating sites as they intensively do with the everyday unearthed archeological objects. In addition, the available diagnostic tools that have been already utilized successfully in similar exceptional items should also be carefully regarded. The Saltmen of Chehrabad salt mine (12), Ötzi, also called the Iceman (13), and the other invaluable findings like the artificial eye found in Shahr-i Sokhta of Bronze Age of Iran (14), are of these priceless instances which are not usually attainable everywhere.

Confronting such unique findings in archeological studies leads the researchers in finding innovative means of identification. During the paleopathological investigations as interdisciplinary research, creating applied techniques will be more possible through exchanging experiences amongst the team members. As we look at this burial more clinically now, providing a more detailed description of this medieval patient seems valuable. As the exact position of these calcified objects was not recorded during the fieldwork it is assumed that they were initially located in the thoracoabdominal as they have been isolated together with commingled bones from this anatomical region (i.e., costal and vertebral fragments).

Moreover, a glance at the literature indicates that approximately 75% of hydatid cysts may form in the liver and rarely in other internal organs (15). However, our presented medieval case might have suffered from hepatic hydatidosis. According to pathogenesis and the progression of hydatidosis, which the infection could be mostly acquired in childhood and its symptoms will gradually appear in adulthood (ADULT), the presented case might be described in the same scenario. Meanwhile, the Roman case with incomplete mineralization of the roots of the third molar (16) and the degree of bone maturation (17) is determined as an adolescent individual whose age-at-death was comprised between 16 and 19-year-old. The sex also did not determine due to the ossa coxae’s destruction.

Furthermore, concerning the laminated layers observed in the present case of Amiens and the fact that the intact laminated layers are not typically visible in fully calcified hydatid cysts (18,19), observing these characteristic structures could be attributed to partially calcified chronic hydatid cysts. Since the skeleton does not display any obvious bone lesion, the presence of those calcified cysts suggests that the individual may have suffered from a pathological disorder. Since the cause of death was not directly emphasized in the previously published paper for the individual of 3rd–4th century AD, the threatening consequences of cystic hydatidosis and its possible reinfections should not be possibly overlooked.

However, the obstructive effects, the cirrhotic process of the disease, as well as coinfection with capillariosis demonstrated in the mentioned article must be also regarded as the possible cause of death in this file of the Roman individual. Now that the importance of recognizing these biological remains is well cleared it is also important to mention that despite five decades of the advent of CT scan in the world medical sciences, the use of this technique on excavated skeletons is widely used in projects. In patients, CT is capable to detect cyst wall or septal calcification in a frequent postcontrast enhancement with high sensitivity and specificity for HD (20) along with most clearly depicting the levels of gas or air within the cyst (21). Although some severe large pathological signs have been occasionally described from anthropological views using CT-Scan, however, the more available capabilities of these technical facilities have been neglected. Of course, to some extent, taking advantage of this technology has been practically used in Thirteen Natural Mummies from Italy, through which the history of diseases and living conditions in ancient populations can be described (22). Applying of CT-scan imaging technique for calcified hydatid cysts exhumed from one of the graves from the ‘Avenue Charles de Gaulle’ burial ground is reemphasizing this previously reported finding in 2014. Therefore, following our previous X-ray microanalysis detecting calcium and phosphorus oxides, calcite, and apatite components, through XRD and XRF techniques (6), to attain a complete illustration of the same cystic objects, performing of dual-energy dual-source CT-Scan was carried out.

The capability of dual-energy in detecting the chemical composition of the material re-confirmed the texture of the Hydatid cysts. At the same time, with this new spectral imaging method that determines the essential elements according to their atomic numbers, image contrast optimization and metal artifacts reduction can also be attainable (23). On the other hand, the interested parasitologists working along with the archeologists on the field should also think to apply CT prior to any destructive procedure as well. In this case, radiologists are fortunately enough openhanded to maneuver a wide range of radiation for archeological objects regardless of recommended ALAP in the clinics.