Lung Hydatid Cysts Research Articles

Single- Stage Transdiaphragmatic Surgical Approach to Liver & Lung Hydatid Cysts

Single- Stage Transdiaphragmatic Surgical Approach to Liver & Lung Hydatid Cysts

One-staged anterolateral thoracotomy for bilateral lung hydatid cysts

Background: Hydatid cyst disease is still a health problem in many countries. Surgical removal is the treatment of choice for lung hydatid cysts. However, operating on bilateral lung hydatid cysts is still controversial. The aim of this retrospective study was to evaluate the results of surgical treatment in bilateral hydatid disease of the lung. Methods: In this retrospective study, we reviewed our experience in the surgical treatment of 22 patients with bilateral, and at least three, lung and liver hydatid cysts. These 22 patients (14 male, 8 female) with an average age of 22 years (range 5–50 years) underwent one-staged bilateral anterolateral thoracotomy. Results: Out of 316 patients with hydatid lung, 22 (5.55%) were managed surgically. In total, 48 lung cysts were removed from 22 patients who underwent one-staged bilateral anterolateral thoracotomy. The most frequent symptoms were cough, chest pain, and dyspnea. Most of the cysts (38.2%) were located in the right lower lobe. Three patients had cysts associated with hepatic hydatid cyst; they were treated through phlebotomy during thoracotomies. All cysts were evacuated with capitonnage and without lung resection. We observed some complications such as prolonged air leaks (n = 3), atelectasis (n = 2), pneumonia (n = 2), and empyema (n = 1). No further surgery was required for the management of complications. The mean hospital stay was 5 days (range 8–12 days). No deaths occurred in hospital stay. Oral albendazole was started on the 2nd postoperative day thoracotomy in the dose of 10 mg/kg and was continued for 3 months with a gap of 2 weeks after each 28 days. No recurrences occurred during the follow-up period. Conclusions: One-stage surgery is superior to a classic two-stage approach as it decreases the morbidity, hospital stay, and costs. MS is an excellent approach, but in some cases, video-assisted thoracic surgery mini-thoracotomies could be indicated. In our experience, one-staged bilateral anterolateral thoracotomy is an appropriate surgical option for bilateral pulmonary hydatid cysts because morbidity rates are minimal, and the hospital stay is acceptable for the treatment of bilateral pulmonary hydatid cysts in one-staged option.

CT Scanning in Identification of Sheep Cystic Echinococcosis.

Objective We aim to determine the efficiency of CT in identification of cystic echinococcosis in sheep. Methods Fifty-three sheep with liver cysts confirmed by ultrasonography were subject to CT scan to evaluate the number, size, and type of the cysts in liver and lung, confirmed using necropsy. The correlation of numbers between liver cysts and lung cysts was calculated using Pearson analysis. Results Necropsy indicated a 98% consensus on size, location, number, and activity compared with CT scan. The viable cysts were 53.1% and 50.6% in the liver and lung, respectively. Among the cysts in liver, 35.5%, 9.5%, 5.7%, 10.2%, and 39.1% were Types CE1, CE2, CE3, CE4, and CE5, respectively. The cysts in the lungs, 17.4%, 26.9%, 12.1%, 11.6%, and 32.1%, were Types CE1, CE2, CE3, CE4, and CE5, respectively. A significant correlation was noticed between the number of cysts in liver and those in lung (R = 0.770, P < 0.001). Conclusions CT scan is a suitable tool in determining the size and type of cystic hydatid cysts in both liver and lung of sheep. A significant correlation was noticed between the numbers in liver and lung, indicating that lung infection was likely due to the expansion of liver cyst burden pressure.

Ishod multivisceralne ehinokokoze - prikaz slučaja

Introduction: The pathogen of multivisceral echinococcosis is the same agent as for single organ echinococcosis: Echinococcus granulosus. According to the consensus of experts under the aegis of the WHO-IWGE-WHO-Informal Working Group on Echinococcosis options of treatment should be: (1) percutaneous treatment, (2) surgery, (3) anti-infective drug treatment or (4) watch and wait approach or combinations thereof. Case report: The presented case was a seven-year-old Caucasian boy, a permanent resident of rural region near Tuzla, Bosnia and Herzegovina, who had a history of asymptomatic giant liver and small lung hydatid cyst (multivisceral echinococcosis). We consider that the patient was in the phase of secondary hydatidosis even before undergoing the first treatment PAIR method of liver and continued with adjunctive chemotherapy. Two weeks after discharge, during the adjunctive chemotherapy he had one of possible complication where pre-existed small lung hydatid cyst got inflamed and performed an abscess mass and potential septic risk, which required surgical and antibiotic treatment. Surgery and early postoperative course were normal and the patient was discharged with recommendation to continue with previously started adjunctive chemotherapy (Albendazol) according to treatment protocol. Conclusion: Most infected persons are asymptomatic and clinical manifestations vary according to the anatomic location of the cyst, so we want to indicate the importance of routine ultrasound screening of preschool children, and eventually X ray chest scan. This case report highlights the necessity of caution with choosing appropriate treatment, even though size of cyst can be irrelevant to take surgical treatment in first line instead of medical therapy.

Is Anatomic Lung Resection Necessary in Surgical Treatment of Giant Lung Hydatid Cysts in Childhood?

The aim of this study is to evaluate the results of parenchymal saving methods for giant lung hydatid cysts and to discuss the necessity of anatomic lung resection in childhood. The patients under the age of 16 years who were operated between January 2000 and January 2017 due to pulmonary hydatid cyst were evaluated retrospectively (n = 200). In all, 32 patients who had giant hydatid cyst were included in this study. Parenchymal saving methods (cystotomy-capitonnage) were preferred and decortication was also performed for pleural thickening if needed. No lung resections were applied. Male patients were 53.1%. The mean age was 11.3 ± 3.2 years. The total number of giant cysts was 32. The average size of the cysts was 11 cm. Thirty seven point five percent of the cysts were perforated. Postoperative complication rate was 31.3%. No recurrence and mortality were seen during follow-up period. Considering the high recovery capacity of lung tissue, a chance should be given to recover the existing infection, atelectasis, and parenchymal damage. Especially in areas where hydatid disease is endemic, children may be infected with the parasite again. For these reasons, we do not recommend resection with any indications.

Diagnosis and treatment approaches of the lung hydatid cysts in childhood

Diagnosis and treatment approaches of the lung hydatid cysts in childhood

A Rare Primary intramuscular hydatid cyst misdiagnosed as malignant spindle cell tumor: A Case Report

Primary hydatid disease of musculoskeletal system is rare. A 46 year old man presented with soft swelling in anterior aspect of thigh of two years duration which was gradually increasing in size. He was initially diagnosed as malignant spindle cell tumor of thigh, but ultrasonography and Commuted Tomography Scan revealed to be a cystic swelling suggestive of hydatid disease. Our patient had not been operated for hydatid disease previously and investigations did not reveal any hydatid cyst in liver, lung or spleen. So our patient was diagnosed having primary hydatid disease of musculoskeletal system. Serologic test (ELISA) was negative. Patient was given albendazole preoperatively. A careful management is required to prevent systemic dissemination and anaphylactic shock. The swelling was removed en bloc without causing damage to cyst wall and advised for adjunctive albendazole chemotherapy (15 mg/kg/day) for three months.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.628-630

Sudden Death in a Case of Isolated Hydatid Cyst of Lung –A Case Report

Death is said to be sudden or unexpected when a person not known to have been suffering from any dangerous disease, injury or poisoning is found dead or dies within 24 hours after the onset of terminal illness (WHO). According to some authors, sudden deaths as those occurring within 6 hours of last illness.In view of modern diagnostic tools available, Sudden death are those occurs instantaneously or within one hourof onset of symptoms. Unexpected character of death, rather than suddenness of death is important. The incidence is approximately 10 % of all deaths. Sudden death May be due to- (a) Natural Causes(b) Unnatural Causes.Natural cause of deathmeansthe death was caused entirely by the disease, and the trauma or poison did not play any part in bringing it about.Causes may be due to (I) Diseases of the Cardiovascular System (45 to 50%) (II) Respiratory System (15 to 23%) (III) Central Nervous System (10 to 18%) (IV) Alimentary System (6 to 8%) (V) Genito-urinary System (3 to 5%)(VI) Miscellaneous (5 to l0%). Negative Autopsy may appear in sudden natural death cases due to (a) Cardiac Arrest(b) Neurogenic shock / Vasovagal attack(c)Epileptic fit(d) Anaphylaxis(e) Hypoglycaemic shock(f) Electrolyte derangements. Here in the following case a 7 year old boy died with 2 hours after one episode of vomiting, where autopsy was suggestive of ruptured hydatid cyst of left lung which was further confirmed by Histopathological examination. No deposits were detected in other organs, suggestive of a primary alveolar Echinococcosis which is extremely rare in the sense that most of the cases lung deposit is secondary to liver being the primary one.

HYDATID CYST – A CHALLENGING DIAGNOSIS AND TREATMENT MATTER FOR THE YOUNG PRACTITIONER - THE MANAGEMENT OF A COMMON PATHOLOGY WITH FREQUENT COMPLICATIONS

The hydatid cyst, or echinococcosis, is a parasitic disease whose etiologic agent is Echinococcusgranulosus, a parasite pertaining to the Cestodes class. Most commonly, in humans, the disease istransmitted digestively, through the eggs of tapeworms found on the animal fur. In echinococcosis,the existence of an occupational risk for animal breeders was identified, which explains farmingRomania as a hyperendemic country. The complicated clinical picture of Echinococosis maypossess hurdles for the young practitioner, in his endeavor to establish a correct diagnosis. Thispaper presents the particular case of a 49-year-old man, diagnosed with lung hydatid cyst, withoutevidence of liver injury, even though the normal life cycle of the parasite involves liver passage. Atfirst glance, the patient arrived in a hospital department complaining of febrile symptoms withpurulent cough and chest pain that does not resonate with the clinical picture of a hydatid cyst, aswas later discovered from anamnesis. From the patient's medical record, it stems that the patientrefused surgical interventions, and followed an antiparasitic treatment for a year.In the eyes of ayoung practitioner, all this information hampers the differential diagnosis, delaying the decision ofaddressing the patient’s problems through a surgery.In a general sense, depending on the organthat is affected, the most important part of the treatment of the hydatid cyst is represented by thesurgical approach, which must be adapted to each case, taking into account the existingcomplications, the risks that may arise, the anatomic and pathologic substrate of the patient.Thelaparoscopic approach is preferable because of the aesthetic result, but in this case, a classicalmethod was used, because of the high risk of complications during and after surgery.

Uncommon Hydatid Cyst in Lung

Echinococcosis also called as hydatidosis is the important zoonotic diseases caused by Echinococcus granulosus. The parasite resides in the intestines of dogs, cats as well as in sheep. Eggs are eliminated with feces and they contaminate fields, irrigated land and wells. Primary host animals ingest the eggs, which develop into larvae, or hydatids in the intestine of these animals. Man acquires the disease through water or food or by direct contact with dogs. The embryos are released once the eggs reach stomach. Through the intestinal wall, they reach the veins of the liver, forms vesicles and develop into hydatids. They can reach lung once they cross liver. Various path to reach lungs are lymphatic vessels, bypassing the liver, and through the bronchi [1]. Hydatid disease involves the liver commonly in approximately 75% of cases, with uncommon presentation in lung [2-4].

Field Investigation on Cystic Hydatid Infection in Man and Camel in Tambool Town and Khartoum State Hospitals, Sudan

Echinococcosis/hydatidosis is a zoonotic disease. The disease is caused by adult worms and larval (metacestode) stages of the taeniid cestode Echinococcus granulosus. The life cycle is completed into two hosts. The final host usually carnivore e.g. dog, and the intermediate host usually herbivorous and man. The aim of this study is to evaluate the fertility of cysts and viability of protoscoleces in man and camel hydatid cysts in order to determine the prevalence of their fertility and to study the association with variables typical of host and of the parasite. Material and methods: Across-sectional and observations study was done in biological material (the fluid from human and camel hepatic and lung hydatid cysts). The viability criteria used were ovoid form invaginated scolices and intact calcareous corpuscles. The presence of vibrating movements, and the absence of “vital” staining, the cysts were grouped in diameter cysts from small cysts to very large size of cysts. Descriptive statistics were for the calculation of the prevalence of fertility, analytical statistics for comparison of groups, and multivariate analysis for examination of the association between cyst fertility and clinical variables. Results: A total of 99 cysts with less than 2 cm 5 (7.8%), from 2-6 cm 52 (81.2%,) medium diameter 6-10 cm 37 (57.8%), and more than 10 cm 5 (7.8), and prevalence of general fertility 68%, sterial cysts was 6%, supporative was 10% and calcified was 15%. Most of camel fertile cysts had medium size (81.2%), while the lowest rate belongs to the small cysts (7.8%). There was significant relationship between fertility of the cyst, type of infected organs, type of animals and size of cyst. Association with location, type, and diameter of the cyst, the viability Protoscoleces was assessed by microscopic observation of biological feature represented by muscular movements, flame cell activity in 0.1% aqueous eosin stain. Conclusion: The differences between prevalence rates, the fertility of hydatid cysts and diversity sites localization observed in humans and camels. Fertility is associated with the type of cyst, location type, type of animal and size of cyst.

Surgery of Cardiac and Multi-Organ Hydatidosis Involvement: Case Report and Review of the Literature

Multivisceral location of cardiac hydatid cyst is exceptional. A 37 year-old female, with past medical history of surgery of hydatid cyst of the right lung, underwent a systematic radiological follow-up. CT scan defined a cystic mass of the heart, of the left lung, the liver, and cysts in the two breasts. So, the patient was operated under cardiopulmonary bypass via a sternotomy. Intra-operative examination revealed a cyst of the inferior wall of the left ventricle. The cysts of the heart, the lung, and the breasts were excised in a single session, and the patient was discharged on the fourth postoperative day without symptoms. The cyst of the liver was operated one month later.

Conservative Surgical Management for Pulmonary Hydatid Cyst: Analysis and Outcome of 148 Cases.

Background. Hydatid cyst (HC) disease is endemic in many developing countries, like Yemen, Egypt, and Saudi Arabia, especially in the rural regions. The disease has a variable clinical courses and even might be asymptomatic for many years. Objectives. In giant and large pulmonary hydatid cysts, pulmonary resection is the usual method of surgical treatment. In this study, we aimed to evaluate the lung conservative surgery in treatment of cases with giant and large hydatid lung cysts, as an effective method of management. Patients and Methods. Between January 2009 and August 2014, a total of 148 patients with pulmonary hydatid cysts were operated and their data was reviewed retrospectively and analyzed. Out of these cases, 52 (35.14%) cysts with more than 10 cm in diameter and 36 (24.32%) cysts with 5–9 cm were regarded as giant and large hydatid lung cysts, respectively. The small cysts less than 5 cm were presented in 8 (5.4%) cases only; other cases had ruptured cysts. Preservation of the lung tissues during surgery by cystotomy and Capitonnage was our conservative surgical methods of choice. Results. Eight patients developed bronchopleural fistula (BPF); of them, 4 BPFs have healed with chest tube and physiotherapy, but in the other 4 patients reoperation was done for the closure of persistent BPF. No mortality was observed in the present study. Conclusion. We conclude that conservative surgical procedure can achieve complete removal of the pulmonary hydatid cyst. Enucleation of the intact huge cysts is safe. Careful and secured closure of the bronchial communication should be done by purse string or figure-of-8 sutures, with or without Teflon pledgets. These simple procedures are safe, reliable, and successful.

Multiple Lung Hydatid Cysts and Cardiac Hydatid Cyst: A Rare Presentation

Hydatid cysts are commonly present in liver. Cardiac hydatid cysts are very rare and represent less than 2% of all cases of hydatidosis. They can occur as widespread infection or as an isolated event. We present here a case with multiple lung hydatid cysts and a single cardiac hydatid cyst involving the apical antero-interventricular septum. A brief overview of disease and the investigations to establish the diagnosis is discussed here with introduction.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.393-395

Surgical and Molecular Evaluation of Pediatric Hydatid Cyst Cases in Eastern Turkey

Cystic echinococcosis (CE) caused by Echinococcus granulosus is a major public health problem worldwide, including Turkey. The aim of the current study was to identify the strains and to estimate the potential risk factors of E. granulosus in operated pediatric cases in eastern Turkey. Ten pediatric patients (7 boys and 3 girls) living in rural areas, with ages ranging from 3 to 15 years old and various clinical histories, were included in this study. Eight patients had only liver hydatid cyst, while 1 patient had liver and lung hydatid cyst and the other liver, lung, and spleen, together. There were 2 ruptured liver cysts. After surgery, during follow-up, no increase was observed in hemagglutination levels, there were no mortalities, and there was no evidence of recurrence at 2 years post operation in all patients. Molecular analysis was performed on hydatid cyst samples obtained from the 10 pediatric cases. According to mt-12S rRNA PCR results, all cases were found to be G1/G3 cluster of E. granulosus sensu stricto.

Giant Pulmonary Hydatid Cyst and Trauma in a 9 Year-Old Child: A Case Report.

Herein, we report a case of giant lung hydatid cyst in a nine-year-old boy. For four years, he experienced mild chest pain and chronic nonproductive cough. He had a trauma resulted from a fall two days before admission. Chest X-ray showed misdiagnosed massive pleural effusion, and was aspirated in the other hospital. However, after admission, the computed tomography revealed a giant lung hydatid cyst filling the right hemithorax completely. Being considered by the diagnosis of ruptured lung hydatid cyst, he was treated surgically by right-thoracotomy. The existing hydatid cyst, (e.g., with a dimension of 30*22*20cm) filled all cavity of hemithorax extended from the right diaphragm to the apex of the lung situated in the right lower lobe. After evacuation of the hydatid fluid and laminated membrane, right lower lobectomy was carried out due to remaining no salvageable parenchyma without any complications. Also, the pathologic examination have confirmed hydatid cyst. In conclusion, giant hydatid cysts are probably misdiagnosed with massive pleural effusion in the endemic area. And, because of the risk of allergic reactions, anaphylactic shock and dissemination, it should not be aspirated.

Severe Vascular Complications Due to Liver Hydatid Cyst Relapse: A Case Report and Review of the Literature

Vascular complications of liver hydatidosis are infrequent but severe. We present a case with severe vascular problems due to a recurrence of a liver hydatid cyst. A 39 year-old male consulted the Emergency Department after frank hematemesis due to esophagealvarices. He had undergone surgery at the age of seven in his native country for liver and lung hydatid cysts. Abdominal CT showed a 20 cm multivesicular cyst, occupying segments IV, V and VIII of the liver, displacing and partially compressing a dilated portal vein and causing portal hypertension and obstruction of the inferior cava vein. A subtotal cystectomy was performed. After surgery, portal vein flow was normal and esophagealvarices disappeared, but caval obstruction remained. We review the vascular complications due to liver hydatidosis, focusing on therapeutic management. performed a subtotal cystectomy and left a lar ge drain in the cyst cavity. Postoperatively, the patient presented low output biliary fistula that did not require any treatment. The microbiological study of the liquid of the cyst confirmed Echinococcusgranulosus infestation.

The Earliest-Known Extant Motion Picture of Anesthesia in the World was Filmed in Buenos Aires

In Buenos Aires, Argentina in 1899, the earliest known extant motion picture featuring anesthesia was filmed by French cameraman Eugenio Py. His Elgé camera captured medical student Rodolfo Santiago Roccatagliata chloroforming a patient for lung hydatid cyst extirpation by fellow Argentine, Professor Alejandro Posadas.

Treatment of spontaneous rupture of lung hydatid cysts into a bronchus in children

PurposeWhile several publications have reported the treatment of ruptured lung hydatid cysts (HC) in adults, there is limited information on the treatment of children. This study summarizes the treatment approach and outcomes of 11 children with spontaneous rupture of lung HCs into a bronchus. MethodsThe complete medical records of 11 patients with spontaneous lung HC bronchus rupture between March 1993 and April 2012 were examined retrospectively. Gender, age at the time of diagnosis, patient symptoms, lung localization, dimensions of the cyst, medical treatment duration, and associated morbidities were evaluated. Routine chest x-rays, ultrasonography, computed tomography and serological tests were used. ResultThe study included 11 patients [4 males, 7 females; average age 7.45 (range 5–11) years] presenting to the Emergency Department. The symptoms at the time of presentation were coughing in 81.8% (n=9), hemoptysis in 54.5% (n=6), and chest pain in 54.5% (n=6). The average cyst diameter was 8.71(35–15) cm. The rupture involved the left lung in 7 (63.6%) patients and the right in 4 (36.4%). Serological tests were positive in seven patients and all patients had eosinophilia. The treatment of one patient was discontinued, while all of the other patients were treated medically. Pneumonia developed in four patients and lung abscesses in two. Both patients who developed lung abscesses had cysts with diameters greater than 10cm. The average follow-up period was 48.4 (range 15–85) months; no mortality occurred. ConclusionIn our experience, medical treatment is adequate for patients with lung HCs progressing to spontaneous bronchus rupture. There was a high rate of abscess development within the thoracic cavity in patients with cysts over 10cm in diameter; these patients can be treated effectively with a medical approach.

Anaesthetic management of intraoperative airway obstruction by ruptured hydatid cyst of right lung and barotrauma induced pneumothorax of the contralateral lung.

Sir, We present a case of anaesthetic complications of ruptured hydatid cyst of lung causing obstruction of double lumen tube (DLT) by daughter cysts on the operative side as well as on the healthy side. A 22-year-old female was posted for cystectomy of the right sided hydatid cyst. Besides routine monitoring, invasive blood pressure was also measured. Anaesthesia was induced with intravenous fentanyl (100 μg), propofol (100 mg) and vecuronium (6 mg). The patient was intubated with 37 FG left sided, DLT in a semi-sitting position. The position of the tube was confirmed with a fibreoptic bronchoscope (FOB) in the supine position as well as in lateral decubitus position. Intraoperatively cyst was found ruptured, and during its handling, we found that hundreds of daughter cysts blocked the tracheal lumen. So we clamped the tracheal end of DLT and one-lung ventilation (OLV) was provided with 5-6 ml/kg of tidal volume and 100% oxygen and subsequently suctioned out hundreds of daughter cysts from the tracheal lumen. About 45 min after starting OLV, we found bronchial lumen also being obstructed by the daughter cysts; there was difficulty to ventilate with rapid onset of hypoxia and peak airway pressure rose up to 50 cm H2O. We suctioned the cysts immediately. After cystectomy and capitonnage were being performed, we replaced DLT with appropriate sized single lumen tube. FOB revealed that left bronchial lumen was circumferentially compressed by bronchial mucosa, and there were no changes in bronchial dimensions during positive pressure ventilation. After extubation, there was a drop in oxygen saturation. Chest X-ray showed a left sided pneumothorax and chest drain was inserted which improved patient's oxygen saturation to 100%. The clinical presentation, pre-operative and post-operative complications associated with pulmonary hydatid cysts depends on whether the cyst is intact or ruptured.[1] OLV does not guarantee a safe operation if either DLT is malpositioned intraoperatively, or contralateral lung is involved pre-operatively. In our case, cyst handling during surgery caused the escape of hundreds of daughter cysts causing obstruction of both the lumens of DLT and patient suffered from repetitive episodes of desaturation. This obstruction of major airways made ventilation difficult and led to increased airway resistance and pressures causing barotrauma of the ventilated lung. During surgery, it was not evident due to open chest cavity, but after closure it manifested as pneumothorax of the ventilated lung leading to intercostal drain insertion. Barotrauma from excessive tidal volume and high airway pressure may occur if left sided, DLT is positioned distally such that the entire tidal volume is directed to only one lobe.[2] Nevertheless, peak airway pressures were not excessive in our case during initiation of OLV and FOB showed the tube to be in a good position. During the surgery, the malposition of DLT could not prevent the dependent lung against contamination of cyst contents and tube obstruction by hydatid cyst caused an excessive increase in airway pressure leading to barotrauma of the ventilated lung. It did not convert into tension pneumothorax due to open chest cavity at the time of surgery.[3] Patients undergoing thoracic surgery are at risk of increased airway resistance of dependent lung secondary to secretions and soft tissue obstruction. This produces potential for a ball valve effect, with limitation during expiration resulting in the overinflation of the lung.[4] We extubated the patient, which averted tension pneumothorax after chest closure. Spillage of laminated membrane could probably take place at any stage of anaesthesia, causing airway obstruction and further hypoxemia and asphyxia.[5] Hence, we conclude that one should be vigilant about post-operative pneumothorax in complicated ruptured hydatid cyst of the lung.