Pulmonary Hydatid Disease Research Articles

Imagerie du kyste hydatique du poumon chez l’enfant

Purpose We present the various imaging features of pediatric pulmonary hydatidosis based upon a series of 232 cases. The importance of chest radiographs and thoraco-abdominal ultrasound is emphasized. Patients and Methods A retrospective study of 232 children with pulmonary hydatidosis is presented. The 232 cases (130 boys and 102 girls, age range: 18 months to 14 years) were studied between January 1982 and December 2001. Chest radiographs were available in all cases, chest ultrasound in 156 cases and abdominal ultrasound in 212 cases. CT was only performed in 40 cases. Surgery was performed for all patients. Diagnosis was confirmed with serology tests and/or pathological study of resected cysts. Result The total number of pulmonary cysts detected on chest radiographs was 344. The right lung was more frequently affected than the left (208 lesions). A simple cyst was the most commonly observed lesion (220 cysts). Complicated forms were noted in 118 cases. 180 cysts were observed at ultrasound. A simple cyst presenting as an anechoic mass was noted in 140 cases. In 38 cases, the lesion was heterogeneous. In two lesions endocystic germinal membranes were detected. CT visualized 50 lesions. Thirty three lesions were complicated with endocystic floating or collapsed membranes. Bronchiectasis was observed in seven cases. Conclusion Chest radiographs and thoraco-abdominal ultrasound are very useful for the diagnosis of pulmonary hydatidosis and evaluation of lesion extension. CT is useful for diagnosis of atypical or complicated lesions and to detect bronchiectasis.

Medical treatment of pulmonary hydatid disease: for which child?

There have been many encouraging studies on medical treatment of pulmonary hydatid disease due to Echinococcus granulosus infection. Our aims were to demonstrate the safety and efficacy of medical treatment in pulmonary hydatid disease and to describe a pediatric population who would benefit from medical treatment, especially in respect to the diameter of the hydatid cyst. All patients were treated with mebendazole or albendazole. Treatment outcome was defined as cure, improvement or failure. Among 82 patients, 34.1% were cured, 34.1% improved and 31.8% failed. When 102 cysts were individually evaluated, 36.31% were cured, 32.4% improved and 31.3% failed. The cure and the failure rates were statistically insignificant in cysts treated with mebendazole and albendazole; however statistically significantly more cysts were improved with albendazole. The results were statistically insignificant between continuous and cyclic albendazole treatment. The mean size of successfully treated cysts was 5.3 ± 3.4 cm, but “failed” for cyst with a mean size of 7.3 ± 4.3 cm. There was a positive, weak and statistically significant correlation between the cyst size and treatment results. The major complication was infection. We suggest that selected pediatric patients with uncomplicated pulmonary hydatid cysts sized less than 5 cm should have a trial of medical treatment with a very close follow up.

Kyste hydatique du coeur et des vaisseaux, 4 observations

The lung is the most frequent location of hydatid cysts (HC). Cardiac and vascular HC are rare, and the primary location in the pulmonary artery is exceptional. We report three cases of right cardiac HC cyst revealed by pulmonary hydatidosis, and 1 case of a primary HC of the pulmonary artery revealed by haemoptysis. Treatment consisted in surgical resection of the cardiac and pulmonary artery HC. Post-surgical antiparasite chemotherapy, based on albendazole, was prescribed for all patients. The evolution was towards a post pneumonectomy syndrome in the patient with a HC in the pulmonary artery, major pulmonary hypertension in the case of pulmonary embolic hydatidosis and an extension of the hydatid lesions in the third patient. Treatment is ongoing in the fourth patient with the development of many parenchymatous cysts. Cardiac and vascular hydatid cysts are rare and of bad prognosis. These cardiac and vascular cysts are of poor prognosis because of the risk of rupture and hematogenic dissemination. Treatments are only partially effective and more importance should be given to preventive treatment.

Resection of intrathoracic and subdiaphragmatic hydatid cysts

The goal of surgical therapy in pulmonary hydatid disease is to remove the cyst while preserving as much lung tissue as possible. The surgical method may be different in the intact (simple) and ruptured (complicated) cysts. The operation has two steps: a) removal of the germinative layer, b) management of the residual pulmonary cavity. Simple cysts are generally removed after needle aspiration or enucleation without needle aspiration. Enucleation cannot be performed in ruptured cysts. The lung cavity that remains after removal of the cyst may be left as it is or obliterated by sutures from within the cavity in regard to the size and location of the cyst. However, the bronchial openings in the cavity must be closed by sutures in all cases. Rarely, hydatid cysts can occur in other thoracic structures such as pulmonary artery, chest wall or diaphragm. Those cysts located on the liver dome are operated by transthoracic-transdiaphragmatic approach. The surgical methods performed for the resection of hydatid cysts located in the chest or in the subdiaphragmatic area are presented with an overview of the literature.

Diagnostic value of a dot immunobinding assay for human pulmonary hydatidosis

The diagnosis of human hydatidosis is primarily made using radiological and serological methods. Radiological methods are generally of low specificity and serological methods lack sensitivity, especially for pulmonary disease. In this study the capabilities of a new rapid test, the hydatid antigen dot immunobinding assay (HADIA), which was developed for the diagnosis of pulmonary hydatidosis, were studied and compared with another immunodiagnostic method, indirect hemagglutination (IHA). The study subjects included 18 patients, 9 women, 9 men; range 7 to 63 years; mean 30 years, with surgically proven pulmonary hydatidosis, a control group comprised of 14 patients; viral respiratory infections (1), cirrhosis (2), connective tissue disease (2), taeniasis (3), and 6 healthy donors. We found that the HA-DIA test had a sensitivity of 67% and specificity of 100%, and that the IHA test had a sensitivity of 50% and specificity of 100%. We conclude that HA-DIA is a simple, rapid, low cost assay that does not require instrumentation and has a higher sensitivity than IHA for the diagnosis of pulmonary hydatidosis.

Pulmonary hydatid: Diagnosis and response to hypertonic saline irrigation and albendazole

Background: Pulmonary hydatid is caused by larval stage of parasite Echinococcus granulosus. Although surgery still remains the definitive therapy, various workers have tried albendazole and sterilization of cysts with varying result. Methods: 32 patients(21 males, 11 females) of pulmonary hydatid disease with average age 32.5 years(21–51 years) treated by us between Jan 97 to Apr 2001 were analysed. Diagnosis was established clinically, radiologically and by serological testing. 16 patients who had simple cyst were treated with 20 ml percutaneous hypertonic(20%) saline irrigation of the cyst along with albendazole (400 mg twice a day, 6 cycles of 4 weeks with 2 weeks drug free period between the cycles). 13 patients of complicated cysts were treated with 6 cycles of albendazole. All cases were followed up for one year. 16 patients including three fresh cases were subjected to surgical resection. Results: Pleural involvement was noted in 10 patients. On chest radiography 19 patients had homogenous oval or circular cysts, 6 patients had crescent sign and 10 had water lily sign. After percutaneous hypertonic saline irrigation all patients showed initial regression in size and developed complicated cysts with water lily sign but subsequently there was no regression. Of 13 patients treated with albendazole, 3 patients showed complete resolution and 2 patients showed regression of cyst. All these 5 patients had shown regression during first cycle of albendazole. 16 patients were subjected to surgery (6 after saline irrigation, 7 after albendazole course and 3 fresh cases). No difference was noted in these groups on histopathological examination. Conclusion: From this study it was evident that those patients who demonstrate regression in size during first cycle of albendazole are likely to benefit and improve with further cycles of it. Those who do not respond should be subjected to surgery. Result of percutaneous hypertonicsaline irrigation as scolicidal was not encouraging.

Bronchoscopic Diagnosis of Ruptured Pulmonary Hydatid Cyst Presenting As Nonresolving Pneumonia: Report of Two Patients

The diagnosis and management of pulmonary hydatid disease represents an important clinical problem in areas of the world endemic to echinococcal infection. We report two patients, ages 14 and 34, respectively, who were admitted to our clinic for investigation of nonresolving pneumonia. Neither had responded to antibiotics prior to admission. Chest x-rays demonstrated lobar collapse and consolidation in both patients. Fiberoptic bronchoscopy revealed laminated membrane of hydatid cyst occluding the bronchus of apicoposterior and anterior segmental bronchi of the left upper lobe in the first patient and the anterior segment of the right upper lobe in the second patient. The diagnoses were confirmed at the time of surgery.

Surgical approach of pulmonary hydatidosis in childhood

To review the results of different surgical treatment in hydatid disease of the lung in paediatric patients. A total of 102 children with pulmonary hydatid cysts were treated at the our clinic in the period from 1990 to 2001. There were 59 boys and 43 girls and their age ranged from 4 to 16 years (mean 10.2). Chest radiography, computed tomography and abdominal ultrasonography were the most commonly used diagnostic techniques. The cysts were located in the right lung in 68 patients (66.6%), in the left lung in 30 patients (29.4%), in both lungs in four patients (3.9%). Concomitant liver cyst hydatid was also detected in 12 patients that were located at right lung, and two patients with bilateral lung involvement. All cases were managed surgically. Of 14 cases with concomitant liver and intrathoracic hydatid cysts, right thoracophrenotomy was performed in 12, median sternotomy in one, and phrenotomy in other. Partial cystectomy and capitonnage were the most commonly used surgical methods. Post-operative complication was seen in 10 (9.8%) patients. Infection at the incision site occurred in four patients and air leakage in three. Complications of capitonnage were seen in three patients. One patient (1%) died at fourth post-operative day due to sepsis. Parenchyma protective operations should be performed especially in children living in endemic areas because of the possibility of recurrence of the disease in the future. Single stage operations in suitable cases decrease the cost of treatment and make surgical therapy suitable in both children and young adults, by reducing the hospital in-patient time and morbidity.

Kyste hydatique cardiaque: Deux observations chez des enfants

Diagnosis of a cardiac hydatid cyst is difficult because of the absence of specific clinical signs. This is a rare disease in adults, but even rarer in children.In a 12 year-old girl, operated on for a pulmonary hyatid cyst 4 years earlier, respiratory distress appeared. This was caused by right heart failure secondary to a chronic hyatid post-embolus pulmonary heart. In a 13 year-old boy exhibiting pulmonary hydatosis (first clinical signs 3 years earlier) echocardiography revealed a multi-compartmented cystic image of the anterior wall of the left atrium, with another similar image in the anterior section of the pulmonary infundibulum.These observations illustrate the potential gravity of complications of a hydatid cyst, endemic parasitosis in North Africa (metastatic pulmonary echinococcosis and chronic pulmonary heart). Imaging is crucial for the early diagnosis, assessment of the lesions and follow-up after treatment.

Hidatidosis pulmonar pediátrica: Reporte de 12 años de experiencia

Pulmonary hydatid (PH) disease in children is a frequent cause of referral at our hospital. Patients and Methods : A retrospective study was conducted in children hospitalized for PH disease in the period 1990-2002. Results: 33 children (39 hospitalizations) aged 4 to 13 years were studied. The diagnosis was based on the clinical picture and chest x-ray in 93% of cases. 26 children had complicated cysts. 20 were treated surgically and 14 solely received albendazole. The most common surgical technique was lobectomy. Post-operative complications were: atelectasis (6), bronchopleural fistulas (5) and pneumonia (4). The development of respiratory complications was significantly associated with complicated cysts or pulmonary resection (p < 0.05). Four patients experienced cyst rupture. Discharge within 2 weeks was registered in 24 patients. 19 patients (18 surgical) were free of PH disease upon discharge. Conclusions: Surgical treatment proved to be safe and effective, medical therapy could not be evaluated due to poor follow-up. Newer and future studies are needed to confirm our results.

Quiste hidatídico pulmonar roto en un escolar de Calama

Hydatid disease is a zoonosis which has a varying incidence in Chile according to the geographic location. The Atacama desert has features which make this disease uncommon and likewise presents with special features during childhood. We report the clinical evolution of a 6 year old schoolgirl with pulmonary hydatid disease. Commenting on the presentation, risk factors and treatment, based on a review of the literature and national experience.

Complicated hydatid cysts of the lung: clinical and therapeutic issues

Background The clinical presentation and the preoperative and postoperative complications associated with pulmonary hydatid cysts depend on whether the cyst is intact or ruptured. The aim of this study was to review the problems encountered in treating ruptured pulmonary hydatid cysts and to highlight the risks associated with chemotherapy and the delay of surgical treatment in pulmonary hydatid disease. Methods The medical records for 67 patients of pulmonary hydatidosis were retrospectively investigated. The patients were divided into two groups based on whether the pulmonary cyst was intact (group 1, n = 34) or complicated (group 2, n = 33). A complicated cyst was defined as one that had ruptured into a bronchus or into the pleural cavity. All patients were treated surgically. Data related to symptoms, preoperative complications, surgical procedures performed, postoperative morbidity, hospitalization time, and cyst recurrence were collected from each individual's records, and the group findings were compared. Results In most cases of intact pulmonary hydatid cysts, the lesions were either incidental findings or the patient had presented with cough, dyspnea and chest pain. In addition to these symptoms, the patients with complicated cyst had presented with problems such as expectoration of cystic contents, repetitive hemoptysis, productive sputum, and fever. The differences between the groups with respect to the rates of preoperative complications and postoperative morbidity, frequency of decortication, and hospital stay were statistically significant ( p < 0.05). Conclusions Surgery is the primary mode of treatment for patients with pulmonary hydatid disease. Complicated cases have higher rates of preoperative and postoperative complications and require longer hospitalization time and more extensive surgical procedures than uncomplicated cases. This underlines the need for immediate surgery in any patient who is diagnosed with pulmonary hydatidosis.

Pleural complications of pulmonary hydatid disease.

The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.

Medical treatment of pulmonary hydatidosis: complications and surgical management.

Pulmonary hydatidosis is more frequently encountered in children than in adults. Chemotherapy with oral administration of particular antihelminthic agents (mebendazole and albendazole) has proved to be effective. This treatment, however, may be associated with serious complications that require surgical management. The aim of this study was to define the limitations of medical treatment, the subsequent complications, and their management. During a 16-year period (1985-2001), 36 children with pulmonary hydatidosis (Echinococcus cysticus) were medically treated. Oral antihelminthic agents (mebendazole until 1992 and albendazole thereafter) were given to all these patients. During this treatment, 11 patients developed complications requiring surgical intervention. In seven children, pleural empyema, or the presence of inflammatory residual fluid, was noted. The remaining four developed pulmonary abscess combined with fluid collection within the pleural cavity. In all complicated cases, the mean size of the cysts exceeded 6 cm in diameter at the beginning of medical treatment. At operation, suturing of communicating bronchi was insecure due to inflammation. Postoperatively, three patients had air leakage from the bronchial tree, requiring continuous suction and prolonged hospitalization. One patient presented with pneumothorax 4 months postoperatively and was operated on again. Overall, long-term results were good. We concluded that a) large pulmonary hydatid cysts should not be treated medically, b) incomplete expectoration of the cyst contents after the parasite death may lead to infection through bronchial communication, and c) patients surgically treated for complications following medical treatment are hospitalized twice as long as patients surgically treated in the first place.

Single-stage transthoracic approach for right lung and liver hydatid disease

Objective:Human echinococcosis remains a serious health problem for the Mediterranean countries. Synchronous pulmonary and hepatic hydatid disease may occur in 4% to 25% of cases. Our experience on simultaneous surgical treatment of right lung and liver hydatid disease in patients was reviewed. MethodsBetween 1990 and 2000, 48 patients (33 female patients and 15 male patients) with synchronous right lung and liver dome hydatid cysts were operated with a 1-stage procedure. ResultsSix patients had previous surgical treatment of hepatic (n = 2) or pulmonary (n = 4) hydatid cyst. The pulmonary cysts were diagnosed with radiography in 18 patients and thoracic computed tomography scan in 30. The pulmonary cysts of 9 patients were bilateral. Seventy-five pulmonary cysts were seen in radiological examinations. The diagnosis of hepatic cysts was established with ultrasonography in 18 patients and upper abdominal computed tomography in 30. The total number of hepatic cysts was 48. In cases with pulmonary cysts, cystotomy and capitonnage were performed in 32 patients, only cystotomy was done in 14 patients, and wedge resection was performed in 2. Liver cysts were approached to transdiaphragmatically after the lung cysts had been dealt with and were managed with evacuation of the cysts. In the remaining cases, marsupialization (n = 2), pericystectomy (n = 1), and enucleation (n = 1) were performed. Major postoperative complications were hemorrhage (n = 1) and biliocutaneous fistula (n = 1). Hepatic recurrence was seen in 3 patients (6.2%) and pulmonary recurrence in 1 (2.1%). ConclusionTransthoracic approach is a useful and a safe surgical management of both pulmonary and upper surface of hepatic hydatid cysts.

Is surgical therapy the only treatment of choice for cardiac echinococcossis with multiple organ involvement?

A 25-year-old male patient suffered from multi-organ hydatidosis including cardiac and bilateral pulmonary echinococcosis. Echocardiography revealed the hydatid cyst 20x35 mm in dimension located in the interventricular septum. The patient refused surgery; albendazole 400 mg/day was given orally and was continued for 24 months. The follow-up echocardiography 24 months later showed that the cyst showed regression 15x25 mm in dimension and demonstrated albendazole-induced echocardiographic changes. Medical treatment in hydatid disease might be recommended when the disease is extensive, the surgery is contraindicated or refused by the patient.

One-stage operation for hydatid disease of lung and liver: Principles of treatment

Objective: Hydatid disease is endemic in many countries throughout the world. Although we do not have exact figures, the disease is prevalent in Turkey. A considerable number of patients have additional liver cysts as well. In this study we reviewed our experience with hydatid disease of the lung and liver and discussed the principles of treatment. Methods: From 1971 to 1999, 2509 patients with pulmonary hydatidosis were referred to us, and 485 of them had concomitant liver cysts. Of these, 405 patients had cysts located on the dome of the liver, and they were operated on with phrenotomy through a right thoracotomy. Eighty patients who were found to have concomitant liver cysts in the lower part of the liver were referred to general surgery for a laparotomy. Results: Hydatid cysts located in the lungs were managed by means of cystotomy and capitonnage. For liver cysts, cystotomy and inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. In case of multiple cysts in the liver, needle aspiration was preferred. Twelve major complications, including excessive biliary drainage and bronchobiliary fistula, occurred in these patients. Conclusions: We believe that management of pulmonary and hepatic cysts simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation. Needle aspiration can be applied only for liver cysts. It is absolutely contraindicated in lung hydatid cysts.J Thorac Cardiovasc Surg 2002;124:1212-5

Single-stage bilateral minimally invasive approach for pulmonary hydatid disease: An alternative technique

J Thorac Cardiovasc Surg 2002;124:1021-4

Conservative surgical treatment of pulmonary hydatid disease in children: an analysis of 35 cases.

Hydatid cyst disease is a major health problem for people who live in endemic countries such as Turkey. The definitive cure for pulmonary hydatidosis is still surgical. This study evaluates our experience of treating pulmonary hydatidosis, focusing on the conservative surgical management of children with this disease. We retrospectively analyzed 35 children ranging in age from 3 to 13 years old, treated for pulmonary hydatidosis during a recent 4-year period. The 35 patients had a collective total of 48 cysts. Twenty-seven patients had a single cyst, 7 had unilateral multiple cysts, and 1 had bilateral multiple cysts. Six patients had multiple coexisting liver cysts. The 33 pulmonary cysts were intact and uncomplicated. Of the total 48 cysts, 34 were larger than 5 cm in diameter. Fever, cough, and dyspnea were the most common symptoms and chest radiography gave a correct diagnosis in 96.4% of the patients. Conservative surgical treatment was carried out in 33 of the 35 children (94%). There were few postoperative complications, and no mortality or recurrence in this series. Parenchyma-saving surgical procedures such as cystotomy and capitonnage are the preferred methods of treatment for pulmonary hydatid disease in childhood. These simple procedures are safe, reliable, and successful. Combined medical treatment can be given but not as an alternative to surgery. Simultaneous surgical procedures for coexisting liver cysts may be preferred because of the lower morbidity rates and hospitalization. Ultrasound or computed tomography scanning should be done to detect coexisting liver cysts in every patient with pulmonary hydatid disease.

La chirurgie du kyste hydatique pulmonaire au Mali

Introduction: The pulmonary hydatid disease has not been the subject of many studies in Mali. Objective: List the cases hydatid cyst of the lung operated on in Mali, in order to analyze their surgical aspects. Methods and patients: This is a retrospective study of consecutive and non-selected cases. From 1960 to 2000, eleven cases of the pulmonary hydatid disease were operated on in Mali. The earliest case dates back to 1968 and the most recent was in 2000. All of these patients were taken care of at the « Point G Hospital » in Bamako. Results: Patients were aged between 4 and 42 years, with an estimated average at 20. The gender ratio (F/M) was 1.75. The circumstance leading to the discovery stems from 8 cases of cough. Seven patients had at least a sign of complicated cyst. Out of a total of 12 cysts, 9 were located to the right lung. The treatment of the cyst consisted in a kystectomy accompanied by an atypical resection of the parenchyma on 6 patients and a typical resection of the attacked lobe on 5 others. The operating effects were complicated in 5 cases. No mortality was reported. Anatomopathology confirmed pulmonary hydatidosis in all cases. Conclusion: Paradoxically, the frequency of pulmonary hydatidosis is low in Mali. Patients were consulted late. This explains in part the high level of lobectomy during surgical treatment.