Pneumomediastinum and Pneumothorax as Rare Complications of Ruptured Pulmonary Hydatid Cyst: A Case Report

The rupture of a hydatid cyst into the abdominal cavity is a rare and serious complication. In this retrospective study, we evaluated ten patients who were surgically treated for ruptured hydatid cysts into the peritoneum at a university hospital in an endemic area between 2003 and 2008. There were three female and seven male patients, with a mean age of 34.2 years (range 20-79). Ruptured cysts were located in the liver (7), pelvis (2), and spleen (1). Eight patients had other nonperforated hydatid cysts. Perforations were spontaneous in seven patients and traumatic in three. Patients' diagnoses were done with abdominal ultrasound (3), computed tomography (6), and laparotomy (1). The surgical treatment of perforated cysts were radical (pericystectomy) in one patient and conservative (partial pericystectomy) in the other nine patients. There was postoperative morbidity (surgical site infection) in one patient and one postoperative recurrence of disease in another patient. Mortality was seen in one patient 2 months after operation due to pulmonary hydatid cyst and infection. The rupture of hydatid cysts into the peritoneal cavity should be included in the differential diagnosis of acute abdominal pain in endemic areas. Perforation in a young patient may be the first presentation of hydatid cyst. Multiple hydatid cysts may be a predisposing factor for perforation. Location of the cyst on segment VI of the liver may be a predisposing factor as well. Emergency surgery is the main treatment for intraperitoneal rupture of hydatid cysts and medical treatment should be given postoperatively.

Hydatid cyst, is zoonotic helminthic parasites of Taeniid families having significant economic crisis in the world. A cross-sectional study was conducted from October 2021 to May 2022 to characterize hydatid cyst lesions, analysis of associated risk factors and estimate annual direct financial loss due to hydatid cyst infected organs condemnation during postmortem examination in dromedary camels slaughtered at Addis Ababa, Akaki Kality Municipal abattoir, Ethiopia. A total of 370 camels were purposively sampled and systemic meat inspection was employed to detect the presence of hydatid cyst. Out of 370 hydatid cysts like cases examined in different organs, 96 (25.9%) camels were found harboring hydatid cyst. The percentage of hydatid cyst in adult camels were 29.67%; OR= 1.54 while in young it was 18.55%. Likewise, the prevalence of hydatid cyst in poor, medium and good body condition score was 61.4%; OR= 10.79, 30.89%; OR= 3.30 and 12.11% respectively. Results indicated that age and body condition score had statically significant effect (P<0.05) on prevalence of hydatid cyst. The overall prevalence of hydatid cyst in male dromedary camel was (14.59%; OR=0.83;) found higher than female (11.35%). The overall prevalence of hydatid cyst in camels originated from Borana, East Hararge, Jigjiga, Karrayyu, Matahara, Minjar-shenkora and Wollo were 9.18%, 0.54%; OR= 2.12, 4.86%; OR= 2.06, 3.51%; OR= 1.18, 3.78%; OR= 0.94, 1.08%; OR= 0.78 and 2.97%; OR= 1.31, respectively. Result indicated, origin and sex didn’t have significant effect (P>0.05) on the overall prevalence of hydatid cyst. Out of 96 total infected camels, only 9 (9.38%) cases had hydatid cyst on both lung and liver while the remaining 87 (90.62%) cases had hydatid cysts only in single organs. Of 105 total infected organs, percentage of distribution of hydatid cyst in lungs, livers, spleen and heart were 87.61%, 10.47%, 0.95% and 0.95% respectively. Result showed that out of 105 examined organs of camels, 51 organs harboring less than three hydatid cysts number while 54 organs had greater than or equal to three hydatid cysts. Grossly, hydatid cyst of lung had a shape of cotton ball, implanted in lung parenchyma, filled with clear to slightly turbid fluid, soft and malleable to touch and inside white germinal layer while hydatid cyst on the livers was firm, calcified and strong when it was about to be cut off. Microscopically, hydatid cyst structure overlying organs had a fibrous layer on the external (pericyst), an acellular eosinophilic laminated membrane layer on the middle (ectocyst) and a germinal layer internally (endocyst) and protoscolices were also seen in a lung section. Fibrous layer had infiltration of epitheliod macrophages, lymphocytes and eosinophils showed inflammatory reaction response to hydatid cyst layer and cellular infiltration was lessened when they went away from hydatid cysts. Histopathology of lung infected with hydatid cyst displayed massive alveolar damage, some alveoli was emphysematous, congested capillary, hemorrhage and atelectasis in the fibrous layer. In hydatid cyst infected liver histology, there was hemorrhage, hepatocyte degeneration and cytoplasmic swelling with dilation of nucleus in fibrous layer. Microscopically, hydatid cyst infected heart had not a visible protoscolices and it had weak germinal and lamination layer followed by lymphocyte and epitheloid macrophages infiltration. The total annual direct financial loss due to hydatid cyst was estimated at 86,209.63 Ethiopian birr. Hereafter, this study helps to stress the economic consequences and pathological patterns of hydatid cysts at abattoir, and creation of public awareness and control of stray dogs in order to reduce infection by the parasite were suggested recommendation.

Spontaneous intraperitoneal rupture of hepatic hydatid cyst in a cirrhotic patient: A diagnostic and therapeutic challenge – A case report

BackgroundHydatid disease is endemic in certain areas of the world and it is located mostly in the liver. Intraperitoneal rupture is rare. Rupture may result from trauma or may occur spontaneously from increased pressure of the cystic fluid. Ruptured hydatid cyst is a rare cause of ascites, but should be considered in the differential diagnosis, especially in endemic areas. The diagnosis of ruptured hydatid cyst should be prompt because it requires emergency intervention.Case presentationThe present case refers to a 62 year old Tunisian male admitted in our institution for diffuse abdominal distension. Physical examination was unremarkable except for the presence of ascites. Abdominal ultrasonography showed a large amount of fluid into the peritoneal cavity associated with many intraperitoneal cysts with a scalloping on the liver. It showed also a heterogeneous cystic lesion of the segment II of the liver. Abdominal computed tomography (CT) revealed in addition a fat infiltration and a thickening of the peritoneum. Thus intraperitoneal hydatid cyst rupture was suspected and emergency laparotomy was performed. A yellow serous fluid , containing many daughter vesicles disseminated through the peritoneal cavity was noted. A mass consistent with a hydatid cyst was noted at segment II of the liver with a tear on the inferior surface. Thus, intraperitoneal rupture of hepatic hydatid cyst was diagnosed.ConclusionThe rupture of hydatid cyst into the peritoneal cavity is rare but presents a challenge for the radiologist and the surgeon. This condition is included in the differential diagnosis of ascites in endemic areas.

Background and Aim: Pulmonary embolism because of hydatid cysts is a very uncommon and lethal complication caused by a hydatid heart cyst rupture or a visceral hydatid cyst released into the venous circulation. By utilizing contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), hydatid pulmonary embolism can be differentiated from other types of pulmonary embolism. MRI mainly displays the cystic nature of lesions better than CT. Pulmonary embolism should be kept in mind in patients with hepatic hydatidosis if there is a sudden occurrence of chest pain and dyspnea, particularly in regions where hydatidosis is endemic. This report aims to present the clinical and radiographic features and discuss the diagnosis and treatment procedure of our patient. Case Presentation: Here, we report a 45-year-old man with pulmonary embolism as a consequence of a ruptured hydatid liver cyst in the inferior vena cava. Multiple intra-arterial pulmonary hydatid cyst emboli originating from a hepatic hydatid cyst ruptured into the hepatic portion of the inferior vena cava were seen in our patient. The patient refused the surgical treatment. Therefore, the patient was treated using Andazol (Albendazole) and Cetirizine hydrochloride. Conclusion: The present case is interesting because pulmonary embolism caused by hydatid cysts is a very uncommon clinical entity. There may be difficulties in diagnosing and treating hydatid cysts, and a definitive diagnosis was possible only by a histopathological examination.

Hydatid cyst is a parasitic disease commonly observed in developing countries. In this study, 24 patients treated for multiorgan hydatid cyst disease in our clinic between 2001 and 2011 were retrospectively evaluated. Twenty patients had hydatid cysts in lungs and liver; one had cysts in heart, lungs, and liver; one had cysts in heart and lungs; and one had cysts on left diaphragm and liver. Twenty-one patients underwent posterolateral thoracotomy. In two patients, exploration was performed via median sternotomy. During thoracotomy, five cysts located in the right lung and liver were intervened with phrenotomy. Eighteen cysts were excised by using cystotomy plus capitonnage, four by cystotomy plus pericystectomy plus capitonnage, and two by enucleation. Five of the cases were ruptured hydatid cysts. Four of these patients had received 10 mg/kg/day albendazole treatment previously due to hydatid cyst of liver. The mean hospital stay was 17 days for ruptured cysts and 7 days for non-ruptured cysts. Preoperative medical treatment in patients with multiorgan hydatid cyst causes pulmonary cyst rupture, and eventually leads to morbidity. So, it is advisable that before starting medical treatment, the lungs should be screened for hydatid cysts. J. Exp. Clin. Med., 2013; 30:5-9

Traumatic rupture of an Echinococcus granulosus hydatid cyst in the liver is a rare event. We present the case of an 11-year-old male who sustained a motor vehicle accident and was diagnosed with an intraperitoneal ruptured liver hydatid cyst, identified via CT scan and excised during exploratory laparotomy. Echinococcosis, or hydatid disease, is a parasitic infestation caused by the ingestion of Echinococcus eggs, primarily transmitted through dog feces. This infection leads to cystic lesions, known as hydatids, most frequently involving the liver (50–77 %) and lungs (15–47 %) [1, 2]. Echinococcus granulosus is particularly endemic in cattle-rearing regions of the Middle East. Infected patients often present with vague abdominal pain due to mass effect or spontaneous cyst rupture. However, traumatic rupture of hydatid cysts remains exceptionally rare. This case illustrates the traumatic rupture of a large liver hydatid cyst in an 11-year-old following a motor vehicle crash, managed according to the Advanced Trauma Life Support (ATLS) protocol. Intraperitoneal rupture of hydatid cysts is a rare but potentially life-threatening complication, accounting for 1–16% of cases [3, 4]. Diagnosis is made through ultrasonography and contrast-enhanced abdominal CT. Treatment involves patient stabilization, surgical cyst evacuation, and scolicidal irrigation. Postoperative albendazole therapy, along with regular follow-up, is crucial to prevent recurrence [5].

IntroductionHydatid cyst is an infectious disease caused by « ECHINOCOCCUS GRANULOSIS », it can be asymptomatic or manifests depending on size, location, and relation with other organs, or by complication like rupture. This latter might occur spontaneously or post-traumatic, and it might manifest with an anaphylactic shock, a life-threatening situation. ImportanceAnaphylactic shock is a rare cause of traumatic shock state. Case presentationA 30 years old man with no medical history was admitted to the emergency room after a car accident, on his admission, his Glasgow coma scale was 10/15 with a blood pressure of 80/30 mmHg, he was intubated and stabilized hemodynamically. The full-body CT scan showed no abnormalities except on the thoracic level where it showed a well-limited rounded formation with regular contours containing hydro-aeric level related to ruptured hydatid cyst.After ruling out the diagnosis of hemorrhagic, hypovolemic shock, the diagnosis of anaphylactic shock due to a post-traumatic rupture of the hydatid cyst was maintained. ConclusionPost-traumatic rupture of the hydatid cyst is a rare emergency that requires early diagnosis and management. Surgery remains the principal treatment of ruptured hydatid cyst.Anaphylactic shock is a life-threatening situation with various symptoms; epinephrine is the cornerstone for management of this type of shock.

Pathologic Quiz Case: Large Cardiac Mass in a 24-Year-Old Woman

Introduction: Introduction: The complicated hydatid cyst of the lung is defined as any cyst ruptured in the bronchi tree or in the pleural cavity, infected, and rarely in the pericardial cavity. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including presentation, diagnosis choice of surgical methods. and complication of delay in surgical treatment of pulmonary hydatid cysts. Methods: Between 2016 and 2021, 192 operations operated for pulmonary hydatid cysts, 42 of these patients were complicated hydatid cyst. Presentations were cough, chest pain and dyspnea.Diagnosis tools were CXR and CT-scan of chest. surgical approach was a posterolateral thoracotomy and anterolateral thoracotomyin all patients; a phrenotomy in eight patients and one-stage bilateral thoracotomy in six patients. Results: In 18 patients (67.5%), there were single hydatid cysts; whereas 4 patients (32.5%) had multiple cysts.12 patients had bilateral cyst and 8 had both lung and liver and others organs, 6 patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in 4 patients. Extrathoracic involvement was apparent in 6 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in 4 patients (16%). Conclusion: Complicated hydatid cyst may present with different clinical and radiologically manifestations as a primary lung tumor , pleural effusion ,empyema hydropneumothorax. In patients with suspicious lung masses in endemic area or history of a hydatid cyst in patients a complicated pulmonary hydatid cyst may be in differential diagnosis.

Complicated hydatid cyst of the thorax is important to the clinical approaches and treatment methods in hydatid disease. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including choice of surgical methods, diagnostic clues and to discuss the inherent risks of medical therapy and the delay of surgical treatment in pulmonary hydatid disease. Between 2002 and 2006, 40 operations were carried out in 37 patients whose diagnoses were complicated hydatid cyst. The surgical approach was a posterolateral thoracotomy in all patients; a phrenotomy in two patients and a thoracoabdominal approach in one patient and two-stage bilateral thoracotomy in four patients. The preferred surgical treatment procedure was cystotomy and modified capitonnage, which was carried out in 26 patients (70%). Other procedures included a cystotomy in five (14%) and decortication in six (16%) patients. Segmentectomy was carried out in 1 (3%), and wedge resection in four patients (11%). In 25 patients (67.5%), there were single hydatid cysts; whereas 12 patients (32.5%) had multiple cysts. Eleven patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in three patients. Extrathoracic involvement was apparent in 10 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in six patients (16%). The morbidity ratio was 5%; there was prolonged air leak and atelectasis in one patient each. The mortality ratio was 3% (one patient). The average hospitalization duration for all patients was 5.7 days (range, 3-17 days). The mean follow up was 18.4 months with no recurrence. Complicated hydatid cyst may have different clinical manifestations and may present radiologically as a primary lung tumour. In patients with suspicious lung masses owing to endemic area, history of a hydatid cyst or contralateral or extrathoracic hydatid cyst involvement at the same time should indicate a complicated pulmonary hydatid cyst. Preoperative anthelmintic therapy must be avoided owing to the risk of perforation. Treatment of a complicated hydatid cyst differs from that of an intact hydatid cyst. Anatomic resection may be necessary owing to destroyed lung tissue secondary to suppuration from a hydatid cyst; however, parenchymal preserving surgery is preferable in an uncomplicated hydatid cyst. A modified capitonnage method is recommended for complicated hydatid cyst treatment as it has a low morbidity rate.

Hydatidosis is one of the neglected zoonotic diseases of unrecognised importance that is caused by the dog tapeworm of thegenus Echinococcus. A study on the prevalence and fertility of hydatid cysts was conducted in sheep and goats slaughtered insome abattoirs in Adamawa State, Nigeria. A total of 1,603 animals comprising 760 sheep and 843 goats were examined forhydatid cysts by visual inspection, palpation and incision. A total of 31 (1.93%) of the study population harboured hydatidcysts, comprising 72 hydatid cysts in 13 (1.71%) sheep and 116 hydatid cysts in 18 (2.14%) goats. There was no significantdifference (p>0.05) in prevalence of hydatid cyst infection among sheep and goats. Age –specific prevalence of hydatid cystswas higher in goats 18(2.1%) than Sheep 13(1.7%), goats and sheep that were >3years old recorded highest prevalence(3.25%; 2.32%). There was no significant difference (p>0.05) in prevalence of cysts in different age groups. Prevalence ofcysts was higher in female sheep (1.96%) and goats (2.98%) than male sheep (1.49%) and goats (1.66%), the difference wasnot statistically significant (p>0.05). The number of hydatid cysts recovered in infected sheep was 72(25.0% fertile, 31.9%sterile and 43.0% calcified cysts) and 116 (47.4% fertile, 15.5% sterile and 25.9% calcified cysts) in goats. Highest number offertile cysts were recovered in lungs of sheep and goats (41.7%; 83.7%) than in their liver ( 16.7%; 37.8%). The differencewas not statistically significant (p>0.05). The most commonly infected organ was liver (66.7%) in sheep and lungs (68.1%)in goats. In conclusion, fertility of cysts in sheep and goats may serve as a potential source of transmission of hydatidosis todogs and continuation of its lifecycle. Strict regulation of slaughtering process including proper disposal of infected offalwould minimize transmission of cysts from intermediate to definitive hosts.
 Keywords: Prevalence, Hydatid cysts, fertility, Sheep, Goat, Adamawa State

Hydatid disease is rare; nevertheless, several areas of the world are endemic. Lebanon is one of the endemic countries. This disease requires careful management, as its diagnosis is tough, and its complications are severe and can lead to sudden death. These complications include fistulas, infection, and rupture. Rupture of a hydatid cyst can mimic acute abdomen and show an array of nonspecific symptoms. It could be mistaken for hemorrhagic shock, trauma, or injury to an intra-abdominal organ. The diagnosis of ruptured hydatid cyst should be kept in mind in cattle-raising countries. We report the case of a polytrauma patient who was suspected to have severe intra-abdominal bleeding and hemorrhagic shock, but imaging and laparotomy showed the rupture of a liver hydatid cyst that drove the patient into anaphylactic shock. This article reviews similar cases in the literature and discusses the diagnostic tools, appropriate management, and expected complications.

Hydatid cysts, primarily found in the liver (70%), are caused by parasitic infections and can lead to severe complications such as cyst rupture. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection. Hydatid cysts are a clinical pathology resulting from parasitic infections. They may occur in different organs of the body. However, these are mostly found in the liver (70%). This can cause significant complications including cyst rupture. Several case reports have described various hydatid cyst ruptures; however, only a few have reported an intra-biliary hydatid cyst rupture. A 24-year-old male patient presented with right upper quadrant pain, jaundice, dark urine, and pale stool. Imaging studies, including Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), revealed a beavertail liver, cystobiliary communication and intrahepatic biliary tree-ruptured hydatid cysts. The cyst was in the right liver lobe, which is the most common site for hydatid cysts. Surgical intervention involving laparoscopic de-roofing and cyst removal resulted in a smooth recovery without complications. Several case reports have described various hydatid cyst ruptures; however, only a few have reported originally placed intra-biliary hydatid cyst ruptures. This case report describes a unique instance of a hydatid liver cyst occupying the right lobe with a communicating part with the biliary tree that ruptured showing a concurrent superinfection.

Intrabiliary and Intraperitoneal Rupture of Hydatid Cyst: Report of Two Cases and Review of the Literature