Pulmonary Hydatid Disease Research Articles

Brief original scientific report: a new surgical approach for the treatment of left pulmonary and hepatic hydatid disease

The combination of pulmonary and hepatic hydatid cysts is frequently encountered, and poses a challenge in terms of surgical accessibility. The surgical treatment of the two locations by the same incision (thoracotomy with phrenotomy) has been proposed, but always from the right side. However, applying this technique to the left side seems to be more difficult and unusual. We herein describe a new left-sided technique that was used to treat two patients with pulmonary and hepatic hydatid cysts. The first patient was 14-year-old; he had bilateral pulmonary hydatid cysts and one type I cyst of the left lobe of the liver. The second patient was a 10-year-old female who had a hydatid cyst of the upper left lobe with one type III cyst of hepatic segments 2 and 3. Both patients were operated on via a left lateral thoracotomy through the sixth intercostal space. They underwent cystectomy for the left pulmonary hydatid cysts, followed by padding, and then the hepatic cyst was treated by Lagrot's method via a radial phrenotomy. The postoperative course was uneventful in both cases, with postoperative hospital stays of 3 and 5 days, respectively. This combined treatment of pulmonary and hepatic hydatid cysts by the left-sided thoracic approach is feasible and provides a good outcome. It should be indicated under the same conditions of accessibility and feasibility applied for the right thoracic side.

Recurrence Following Pulmonary Hydatid Disease Surgery

Dear Editor, Hydatid disease is still a major health concern in the World Health Organization’s Eastern Mediterranean Region countries [1]. The disease has the ability to affect all organs, but the liver is the organ most commonly affected followed by the lungs. Numerous modalities have been introduced for diagnosing pulmonary hydatid disease [2]. Surgery, however, remains the treatment of choice, with various approaches used to save as much of the lungs as possible. Recurrences appear because of intraoperative spillage of the hydatid daughter cysts into the pleural cavity, with most studies indicating recurrence rates for pulmonary hydatid disease of 4.6–22.0 % [3–5]. Mahmodlou et al. [1], despite a cyst perforation rate of 29.4 %, reported no recurrences. They compared their results with the study of Mottaghian and Saidi [5] in which a recurrence rate of 1.5–12.0 % had been reported. The follow-up period of the studies conducted by Mottaghian and Saidi [3–5] was 6 months to 3 years, a range reported by most authors to be sufficient for identifying recurrence of the disease, although some use a minimum of 4 years for their follow-up protocol. The follow-up period of the study conducted by Mahmodlou et al. was 6 months, a time span too short to compare their results with those of similar studies or to make any definitive statements about a zero recurrence rate. Accidental rupture or spillage of cysts during the operation might lead to consequent regrowth of the cysts. Thus, the operative field should be kept clear of contamination by irrigating the pleural cavity with hypertonic saline. Also, the cysts should be handled with very gentle manipulation. These precautionary measures along with chemotherapy and a thorough follow-up program might avoid recurrence of the disease.

Saucerization: A Modified Uncapitonnage Method of Surgery for Pulmonary Hydatidosis

There are contrary opinions regarding the surgical treatment of pulmonary hydatid cysts. We report our experience performing a modified version of uncapitonnage surgery, called "saucerization," for treating pulmonary hydatid cysts. A total of 78 patients with pulmonary hydatid cysts were studied regarding their surgery outcome and the complication rate. The procedure used for cyst evacuation depended on whether the cyst had ruptured. If ruptured, cystotomy was done; otherwise, enucleation was preferred. To deal with the residual cavity in an uncapitonnage manner, we removed the thin margins of the pericyst and closed the bronchial openings at the cavity floor. All patients were followed up at least for 6 months. The intensive care unit stay ranged from 1 to 9 days. Incomplete lung expansion (six patients) was the main postoperative complication followed by wound infection (four patients) and persistent air leak (≥7 days) (one patient). There was one death. Dependence on mechanical ventilation and subsequent septic shock were also observed. The other patients exhibited no complications during the follow-up period. Our experience demonstrated a low complication rate associated with removing the thin margins of the residual cavity and changing the shape of it into a "saucer." The results were satisfactory and comparable to the results of other studies on pulmonary hydatid cysts.

LES LOCALISATIONS PULMONAIRES DE L'HYDATIDOSE

Objective: pulmonary hydatidosis is a common health problem observed in Morocco. In this study, our surgical experience was reported according to indications and results of the disease. Materiel and methods : all 1589 patients who were operated on pulmonary hydatidosis between 1993 and 2002 were investigated retrospectively. Results : There were 890 men (56%) and 699 women (44%). The diagnosis was established on the basis of associated clinical signs and radiological finding. Cystectomy was the most common operation performed 607 (38,2%), followed by 220 wedge resection (13,8%), 503 segmentectomy (31,6%), 392 lobectomy (24,6%), 19 bilobectomy (1,19) and 13 pneumonectomy (0, 81%). Recurrence was determined in 49 patients. Mortality was 0, 3% (5 patients), and morbidity was observed in 286 patients (18%). The complications were: infection of the incision (2,8%), pneumothorax (11%), empyema (1,7%) and hemothorax (1,5%). Mean hospitalisation stay was 8-12 days. Conclusion : surgical outcome of the pulmonary hydatidosis is perfect with a low mortality and morbidity rates. In order to prevent the transmission of the disease, all the necessary precautions should be taken.

Abordaje transtorácico para la hidatidosis pulmonar derecha y hepática concomitante

Transthoracic approach for concurrent right lung and liver hydatid cysts Introduction: Pulmonary and hepatic hydatid disease occurs concomitantly in 4 to 33% of cases. When the condition is localized in the right lung and liver dome surgical resolution in one time is possible. Objective: To describe the transthoracic-transfrenic approach and review the available literature. Material and Methods: We report two cases operated at our institution through a right posterolateral thoracotomy and frenotomy in one stage, with uneventful postoperative evolution. A systematic review of the literature was conducted in the PubMed database period 1990-2011. Five studies met the inclusion criteria. Conclu- sions: Transthoracic-transfrenic approach is feasible and safe, allowing the surgical resolution in one time through a single incision, without another anesthetic procedure or subsequent laparotomy, with low morbidity and mortality.

Complicated Hydatid Cysts of The Lung

Introduction Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The organs most commonly affected are the liver and the lungs. Purpose The purpose of this study was to exhibit some characteristics of complicated pulmonary hydatidosis such as the clinical, radiological features and therapeutic option. Methods We retrospectively reviewed the medical and radiological records of patients who had hospitalized for complicated pulmonary hydatidosis at the center for Chest Diseases of Hedi Chaker hospital, Sfax, Tunisia, between 1 January 1993 and 31 December 2013. Results 29 cases (mean age = 36,4 years) were evaluated between 1996 and 2013. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (34,48%) and into the pleur in 13,7%. Extrathoracic involvement was found in 10,3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 80% of the patients. The Fibre-optic bronchoscopy allowed the extraction of hydatid cyst membrane in 10% of cases. Surgical treatment was performed in all cases. Medical treatment was associated in 5 cases. Outcome revealed recurrence of pulmonary hydatidosis in 1 patient, and the death of 1 patient with hemorrhagic shock. Conclusion Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and require pulmonary resections.

Pulmonary echinococcosis with Actinomycetes-like organisms mimicking malignancy: Diagnosed by fine needle aspiration cytology

Pulmonary echinococcosis with Actinomycetes-like organisms mimicking malignancy: Diagnosed by fine needle aspiration cytology

An Imported Case of Echinococcosis in a Pregnant Lady with Unusual Presentation

A 31-year-old Syrian pregnant (25-week duration) patient who was managed as a case of bronchial asthma for one year because of chronic cough and progressive breathlessness presented to the Accident and Emergency Department at Hamad General Hospital, Doha, with cough and shortness of breath. On the day of admission, she coughed large amount of yellowish watery material which was salty and sour in taste. She was found by radiological investigations to have multiple giant hydatid cysts (three in the lungs and one in the liver), with ruptured cyst in the left lung. We report here an unusual case of giant multiple pulmonary hydatidosis localized in the lungs and masquerading as bronchial asthma in a pregnant lady. The case represents an uncommon situation of a common disease of rupture of hydatid cyst of the lung in a pregnant lady in her 3rd trimester.

Hidatidosis cardiaca: caso clínico

Hydatidosis is an endemic zoonosis in Chile. We report a 48-year-old former slaughterman, with a previous history of pulmonary hydatidosis, who presented a stroke without associated cardiovascular symptoms. An echocardiogram revealed a tumor mass with cystic features in the left ventricle. The patient was operated and the cyst was successfully excised. During the follow up, the patient remains asymptomatic.

887 Two Cases of Gigantic Juvenile Cystic Echinococcosis

Background and AimsCystic Echinococcosis (CE) is a serious multi-organ disease, caused by cestode infection with Echinococcus granulosus. Simultaneous hepatopulmonary or isolated pulmonary hydatidosis in children are rare and demand an...

Invasive aspergillosis associated with pulmonary hydatid disease

A patient presented with a cavitating lung lesion. Serology and sputum microscopy led to the diagnosis of pulmonary hydatid disease. However, histology of the operative samples revealed aspergillosis in the cavity and surrounding lung tissue. This is the first report of invasive aspergillosis occurring as a consequence of spontaneous hydatid cyst rupture.

Video-assisted thoracoscopic removal of pulmonary hydatid cysts

Pulmonary hydatid disease is a parasitic disease with a high prevalence in low-middle income countries. We report four patients who were treated surgically using video-assisted thoracoscopy (VATS). All patients were diagnosed with clinical and radiological findings on chest X-ray and computed tomography. Complete thoracoscopic removal by cystotomy and capitonnage was done in all four patients. The procedure included a standard thoracoscopy port incision and a 2-3 cm utility skin incision that was placed just superior to the cystic lesion. In the first case, a small-sized rib separator was used. The following three cases were operated without placing a rib separator on the utility incision. Conversion to open thoracotomy was not required. The average duration of the procedure was 90 min, and the average length of hospital stay was 4 days. No complications were observed after the thoracoscopic removal. At mean follow-up of 4 months, all patients were asymptomatic. VATS removal of the hydatid cysts can be done successfully in peripherally located cysts.

“Water-lily sign” as a rare finding of spinal hydatidosis

Hydatid disease (HD) is a common parasitic infestation in some developing countries. Hydatid disease may affect many organs in the body, but the most affected are the liver and lungs. Hepatic and pulmonary HD is relatively easier to diagnose because of the frequency of pathognomic features and its order in the differential diagnosis list. When HD is located in uncommon sites, it is difficult to recognize even in endemic areas. The "water-lily sign" is a pathognomic sign for HD and mostly described especially after puncture or percutaneous treatment of the cyst. In this case, we observed the water-lily sign in spinal HD, which was not described before for spinal cases but for soft tissues.

Diagnosis of pulmonary hydatid disease presenting with solid nodule and mimicking malignancy by fine needle aspiration cytology

To the Editor, Hydatid disease (HD) is caused by Echinococcus granulosus, endemic in the cattle- and sheep-raising regions of the underdeveloped and developed world.[1,2] The prevalence is rather high in several countries of the Mediterranean region, mainly in pastoral areas where the dog-sheep cycle of the parasite prevails.[3] It also remains a health problem in Turkey, mainly in the rural areas of the eastern part of the country.[4] Hydatid disease predominantly affects the liver and lungs. The relatively rare anatomic locations are the central nervous system, muscles, subcutaneous tissue, kidneys, bones, and body cavities.[1] Pulmonary HD can be diagnosed by clinical and radiological findings, and serological analysis. However, old, arrested forms of the infection presenting with an organized, solid, atypical pulmonary nodule may mimic lung cancer.[5] Fine needle aspiration cytology (FNAC) can be a useful tool in the differential diagnosis.[6] We report a case of pulmonary hydatid cyst presenting with a solid and solitary nodule, clinically and radiologically suspicious for malignancy, diagnosed by FNAC. A 52-year-old female patient presented with a history of dyspnea and cough. Computed tomography (CT) revealed a solid nodular lesion, with a 2 cm diameter, in the apicoposterior segment of the upper lobe of the left lung [Figure 1]. Figure 1 Computed tomography image showing a nodular lesion (red arrow), 2 cm in diameter, in the apicoposterior segment of the upper lobe of the left lung A clinical and radiological diagnosis of lung malignancy was rendered, and subsequently a CT-guided transthoracic FNAC was done.

Flexible bronchoscopy in managing a child with pulmonary hydatid disease

Few articles have described the airway management of parenchymal lung hydatid cysts complicated by endobronchial or airway involvement, and none have described the use of flexible bronchoscopy (FB) therapeutically in children. We present a child with a ruptured pulmonary hydatid cyst who underwent repeated FB for removal of cystic material from an obstructed right upper lobe segmental bronchus. This child did not require thoracic surgery and made a full clinical recovery, demonstrating that in selected cases FB may offer curative treatment.

PULMONARY ECHINOCOCCOSIS - CASE REPORT

echinococcosis is still a serious problem, particularly in endemic areas. Humans are accidental hosts, usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. A 24-year-old woman with pulmonary echinococcosis is presented. A computed tomographic scan of the chest revealed the presence of saddlebag cyst in the parahilar left lung. Laboratory test showed the presence of antibodies against echinococcus granulosus. She was successfully treated by surgical excision. Surgical excision of the cyst is the treatment of choice whenever possible.

Invited Commentary

Invited Commentary

Capitonnage Results in Low Postoperative Morbidity in the Surgical Treatment of Pulmonary Echinococcosis

The main surgical techniques in the treatment of pulmonary echinococcosis are cystotomy alone, cystotomy and capitonnage, enucleation, and pericystectomy. Controversy persists regarding the selection of surgical technique. We reviewed our experience to identify the impact of capitonnage on outcomes. A single-institution retrospective analysis was made of the 308 consecutive patients with thoracic hydatid disease treated surgically during 17 years. The most common presenting symptoms were cough and chest pain. At presentation, 69 patients (22.4%) had complicated hydatid disease, cyst rupture into bronchus in 62 and into pleural cavity in 7. Bilateral involvement occurred in 37 patients (12.0%), simultaneous hepatic cysts in 36 (11.6%), and intrathoracic extrapulmonary involvement in 14 (4.5%). Surgery consisted of cystotomy with capitonnage in 271 patients (92.2%), cystotomy and closure of bronchial openings in 20 (6.8%), and lobectomy in 3 (1.0%). Hospital mortality was zero; postoperative complications developed in 21 patients (6.8%). Cystotomy with capitonnage has a low complication rate. Pulmonary resection is best limited to patients with parenchymal destruction secondary to infection.

Spontaneous enucleated hydatid cyst with tension pneumothorax: a case report

Hydatid disease is a parasitic disease caused by Echinococcus granulosus. The most frequent complication of pulmonary hydatid disease is the rupture of the cyst into a bronchus. In this article, we report the first case of hydatid cyst with spontaneous enucleation into the pleural cavity. A fouryear- old boy admitted with dispnea, cough, high fever, and tension pneumothorax. A cyst was detected in the left hemithorax on chest computed tomography performed after chest tube insertion. During the operation, a free hydatid cyst was observed in the left hemithorax. The cyst was removed, the bronchial openings were repaired, and then capitonnage and total decortication were performed.

Parenchyma Sparing Procedures Is Possible For most Pulmonary Hydatid Disease Without Recurrence and Low Complications

A retrospective review of 223 patients (242 operations) of pulmonary hydatid cysts. We analyze and evaluate our experience in the surgical management of this Moroccan endemic disease and concluded that parenchyma-saving must be always used. In an 8 year period (2002 -2009), 223 patients (242 interventions, 282 pulmonary hydatid cysts) were operated on in our department. There were 166 males and 57 females with a mean age of 45.7 years. The diagnosis was established on the basis of different clinical signs and imaging studies. Surgical approach consisted of a posterolateral thoracotomy in all cases. Different surgical procedures were performed on the pulmonary lesions according to the localization, the size, the complicated or intact cyst and the importance of lung destruction. Parenchyma-saving were done in 217 patients (238 interventions) cases, including cystectomies (189 cysts), pericystectomies (47cysts) with capitonnage of the cavity in 177 cysts. Radical treatment as lobectomies is used in only 6 cases. Postoperative minors complications occurred in 13 cases (5.4%), including 6 prolonged air leak, 4 pneumonias, one wound infection and two transitory residual cavities. There was no postoperative death. All patients were free of recurrence of thoracic hydatid disease in a follow-up ranging from 3 to 90 months (mean: 49 months). Hydatid cysts of the lung should be treated before complications. Parenchyma saving is the best procedures for this benign disease; the radical resection must be reserved only for pulmonary destruction.