Primary Hydatid Cyst of the Chest Wall

Abstract

A 69-year-old female was examined in the emergency room for abdominal pain that had recurred during the preceding 4 years. During the physical evaluation no pathology was determined, except for sensitivity to deep palpations in the upper right quadrant of the abdomen. On the chest roentgenogram, a nonhomogeneous dense area with calcific foci was observed adjacent to the right costophrenic sinus (Fig. 1). The thorax tomography revealed a mass lesion of 5 9 6 cm with calcification, which was located in the chest wall of the lower outer region of the right hemithorax (Fig. 2). Abdominal ultrasonography showed a mass that was pressuring the right lobe of the liver from the outside. The acid-fast bacillus test was negative and other laboratory tests were within normal limits. The results of the transthoracic fine-needle aspiration biopsy indicated the presence of necrotic tissue material containing calcifications. The patient was admitted for surgery with the prediagnosis of chest wall tumor. The mass was completely removed by excisional biopsy (Fig. 3). A 7 9 7 cm defect caused by the en bloc chest wall resection was reconstructed using the M. serratus anterior muscle flap. During the histopathological examination, germinative and cuticular membranes showed dystrophic calcification and chronic inflammation, and a hydatid cyst was diagnosed (Fig. 4a, b). The patient was discharged without any complications. Albendazol 15 mg/kg/day was prescribed for 3 months. Upon completion of the 1 year of follow-up, the patient was still asymptomatic and no recurrence was observed, either clinically or radiologically. A hydatid cyst is a parasitic disease caused by Echinococcus granulosus. It is endemic in countries where sheep and cattle farming is prevalent, such as the Middle East, New Zealand, South Africa, and South America. Although hydatid cyst is frequently seen in the liver and lungs, it can lead to disease in any part of the body [1]. Hydatid cysts can be located in the chest wall through to the sternum, ribs, and regional soft tissues. Yilmaz Avci et al. [2] reported that hydatid cysts in the chest wall might form due to either the rupturing of lung hydatid cysts into the pleural space or inoculation. Currently, the primary treatment for hydatid cyst disease is surgery in which all of the parasitic material is removed. Even though the roentgenographic findings are frequently diagnostic for hydatid cyst, in cases where a definite preoperative diagnosis of lesions cannot be reached, a final diagnosis can be made histopathologically through surgical intervention. Thus, the surgical treatment of these patients S. Karapolat Department of Thoracic Surgery, Duzce University School of Medicine, Duzce, Turkey