Bronchoscopic Findings in Patients With Hydatid Cyst of the Lung

Abstract

Introduction Hydatid cyst of lung is mainly diagnosed by imaging procedures such as chest roentgenogram and chest computed tomography scan. Bronchoscopy is not used widely in these patients. The objective of this study is to give a description of the most important findings during the bronchoscopy, and correlation of these findings with radiologic presentation. Materials and Methods All patients diagnosed finally as pulmonary hydatidosis by surgical exploration were included in this study. Diagnostic bronchoscopy was performed for some of them, mainly for assessing unknown pulmonary mass or opacity and evaluating the underlying causes of hemoptysis. During bronchoscopy, whitish-yellow bright gelatinous membrane inside the lumen of bronchus, complete obstruction, exophytic lesions, pus discharge, and mucosal erythema were noticed. Bronchoalveolar lavage (BAL) was studied for scolices, hooklets, and laminated membrane. Results During 26 years period, 1404 subjects with pulmonary hydatidosis were diagnosed and operated. Sixty-two of them underwent diagnostic bronchoscopy (mean age and standard deviation in bronchoscopy group was 41±15 y). Main chief complaints were cough (45%) and hemoptysis (32%). Average and standard deviation of hydatid cyst diameter was 7.17±4.61 cm. Centrally located cysts were significantly larger than peripheral cysts (9.43±5.10 cm vs. to 6.16±4.05 cm, t=2.47, P=0.017). Among patients who underwent bronchoscopy, 60% had positive findings, such as white membrane in 10/62 (16%), mucosal erythema in 26% (16/62), and pus discharge in 5% (3/62). Nonspecific bronchial occlusion presented in 8% (5/62) and exophytic lesion in only 1 patient (1.6%). Hydatid hooklets and scolices in BAL cytology were seen in 2 (3%) subjects and eosinophilia in 6 (6.4%). Perforated cysts were more likely to be associated with exophitic lesions [relative risk (RR)=3.5714, 95% confidence interval (CI)=2.28-5.57] and pus discharge (RR=3.9167, 95% CI=2.40-6.3). The latter also correlated with upper localization of hydatid cyst (RR=3.20, 95% CI=1.21-8.45). Mucosal erythema correlated with central location (RR=2.25, 95% CI=1.02-4.92) of the lesion. Conclusions Bronchoscopy and BAL can provide hints for hydatid cysts in 19% of patients. Radiologic findings do not correlate with endoscopic findings.