Primary mediastinal echinococcosis

Abstract

The clinical and pathologic features of mediastinal echinococcosis are discussed in the light of six cases herein presented and a review of seventy-four cases reported in the literature. In our patients a mediastinal location occurred in 6 per cent of echinococcosis in all sites. The frequency of subpleural-mediastinal location and the role of the subpleural plexus in the pathogenesis of mediastinal echinococcosis is emphasized. Mediastinal hydatid cysts are usually multivesicular, except for those in the middle mediastinum. Fifty-five per cent of all cases of mediastinal hydatid cysts were located in the posterior mediastinum. Erosion of the ribs and vertebrae and compression of the spinal cord occurred in 57 per cent of all posteromediastinal hydatid cysts. In 36 per cent of cases the mediastinal echinococcosis was located in the anterior mediastinum; compression of trachea with severe dyspnea or strangulation was the major complication. In echinococcosis of the middle mediastinum (9 per cent of all cases), compression and erosion of the great vessels is the main danger. Briefly summarized is the differential diagnosis of mediastinal echinococcosis from other mediastinal cysts and tumors, as well as from mediastinal ossifluent hydatid abscess arising from vertebral echinococcosis, from cardiopericardial hydatid disease and from paramediastinal echinococcosis. Various approaches in the surgical treatment of mediastinal echinococcosis are discussed.