Primary Pleural Hydatidosis-A Rare Occurrence: A Case Report and Literature Review.

Camelia Diaconu,Cornel Savu,Carmen Savu,Ovidiu Stiru,Laura Iliescu,Mihai Dimitriu,Bogdan Socea,Vasile Grigorie,Irina Balescu,Valentin Varlas,Nicolae Bacalbasa,Alexandru Melinte

doi:10.3390/medicina56110567

Abstract

Introduction: The larvae of Echinococcus, a parasitic tapeworm, cause hydatid disease. The most commonly involved organ after the liver is the lung but there are cases of hydatid cysts in all systems and organs, such as brain, muscle tissue, adrenal glands, mediastinum and pleural cavity. Extra-pulmonary intrathoracic hydatidosis can be a diagnostic challenge and a plain chest x-ray can be misleading. It can also lead to severe complications such as anaphylactic shock or tension pneumothorax. The purpose of this paper is to present a severe case of primary pleural hydatidosis, as well as discussing the difficulties that come with it during diagnosis and treatment. Case Report: We present the case of a 43-year-old male, working as a shepherd, presenting with moderate dyspnea, chest pain and weight loss. Chest x-ray revealed an uncharacteristic massive right pleural effusion and thoracic computed tomography (CT) confirmed it, as well as revealing multiple cystic formations of various sizes and liquid density within the pleural fluid. Blood work confirmed our suspicion of pleural hydatidosis with an elevated eosinophil count, typical in parasite diseases. Surgery was performed by right lateral thoracotomy and consisted of removal of the hydatid fluid and cysts found in the pleura. Patient was discharged 13 days postoperative with Albendazole treatment. Conclusion: Cases of primary pleural hydatidosis are very rare but must be taken into consideration in patients from endemic regions with jobs that may have exposure to this parasite. Proper treatment, both surgical and antiparasitic medication, can lead to a full recovery and a low chance of recurrent disease.

Highlights

The larvae of Echinococcus, a parasitic tapeworm, cause hydatid disease.The most commonly involved organ after the liver is the lung but there are cases of hydatid cysts in all systems and organs, such as brain, muscle tissue, adrenal glands, mediastinum and pleural cavity
After draining approximately 4 L of ivory-colored fluid from the pleural cavity we discovered several hundred hydatid cysts with sizes ranging from 1–2 mm to 5–6 cm and the right lung was collapsed in the hilum
Primary pleural hydatidosis manifests as the presence of either a solitary pleural hydatid cyst or as a parasitic pleural effusion [5]

Summary

Introduction

The larvae of Echinococcus, a parasitic tapeworm, cause hydatid disease. The most commonly involved organ after the liver is the lung but there are cases of hydatid cysts in all systems and organs, such as brain, muscle tissue, adrenal glands, mediastinum and pleural cavity. The purpose of this paper is to present a severe case of primary pleural hydatidosis, as well as discussing the difficulties that come with it during diagnosis and treatment. Blood work confirmed our suspicion of pleural hydatidosis with an elevated eosinophil count, typical in parasite diseases. Hydatidosis is a parasitic disease caused by the Echinococcus larvae. The primary localization of hydatid cysts is in the liver (60–80% of cases) with the lung being the second most common location (10–30%). Primary pleural hydatid cyst is a very rare occurrence and is most often solitary [5]

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