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Reddy H, Malali S, Dhondge RH, Kumar S, Acharya S. Hydatidosis: A Rare Case of Multi-organ Involvement. Cureus 2024; 16:e57562. [PMID: 38706998 PMCID: PMC11069619 DOI: 10.7759/cureus.57562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Echinococcus granulosus is the tapeworm that causes hydatidosis. The liver is the most frequently impacted region, although it can also affect the spleen, lung, and peritoneum. Dogs are the definite hosts, whereas humans are the unintentional accidental hosts. The peritoneum is an unusual site for hydatid cysts. We report the case of a 42-year-old male who had abdominal distension. A CT scan revealed hydatid cysts in the liver, spleen, and peritoneum. The patient was managed conservatively with albendazole and advised for surgical intervention and removal of daughter cysts. This case highlights the uncommon presentation of hydatid disease involving multiple intra-abdominal organs concurrently. The successful management of such cases necessitates a multidisciplinary approach, encompassing accurate diagnosis, timely intervention, and comprehensive treatment strategies. Furthermore, this case emphasizes the importance of clinical suspicion in endemic regions to optimize patient outcomes and enhance quality of life.
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Affiliation(s)
- Harshitha Reddy
- Internal Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Suprit Malali
- Internal Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | | | - Sunil Kumar
- Internal Medicine, Jawaharlal Nehru Medical College, Wardha, IND
| | - Sourya Acharya
- Internal Medicine, Jawaharlal Nehru Medical College, Wardha, IND
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2
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Reddy A, Mathew JL, Kundu R, Menon P, Gupta K. A Child With a Brief History of Coughing Up Blood. Pediatr Infect Dis J 2023; 42:829-832. [PMID: 37579062 DOI: 10.1097/inf.0000000000003899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Anvesh Reddy
- From the Pediatric Pulmonology Division, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joseph L Mathew
- From the Pediatric Pulmonology Division, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Ahmad AA, Maurice MN, Monib MESM, Soliman M, Al-Thagfan SS, Huseein EAM. Eugenol Essential Oil and Nanoemulsion as Antihydatic Agents with Antifibrotic and Immunomodulatory Effects in Cystic Echinococcosis. Trop Med Infect Dis 2023; 8:tropicalmed8050253. [PMID: 37235301 DOI: 10.3390/tropicalmed8050253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
Conventional scolicidal agents are still unsatisfactory in combating hydatid disease due to their low efficacy and increased drug side effects. Therefore, novel scolicides are required. This study aimed to evaluate the antihydatic and immunomodulatory effects of eugenol essential oil (Eug) and its nanoemulsion (Eug-NE) in cystic echinococcosis (CE). Eug and Eug-NE were administered orally to CE-infected rats and compared to albendazole (ABZ). Hydatid cyst development was assessed based on organ weight and hypertrophy indicators of the infected organs, along with a histopathological and histochemical evaluation of collagen content. The immunomodulatory effects of treatment on CE were evaluated by serum cytokine levels measurement of interferon-γ (IFN-γ) and interleukin (IL)-4 and immunohistochemical (IHC) analysis of signal transducer and activator of transcription 4 (STAT4) and GATA-binding protein 3 (GATA3) markers. Eug-NE was the most effective in reducing the cyst weights, organ weights, and hypertrophy indicators and improving histopathological lesions with reduced collagen content. Eug and Eug-NE significantly increased the IFN-γ levels and decreased the IL-4 levels, while IHC analysis demonstrated a significant reduction in STAT4 and GATA3 expression in all treated groups. Eug and Eug-NE demonstrated antihydatic and preventative effects, with a substantial decrease in liver fibrosis compared to that of ABZ. Besides their promising immunomodulatory effects, their good treatment response suggests their use as alternatives or complementary scolicidal agents in hydatid cyst treatment.
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Affiliation(s)
| | - Maria Naged Maurice
- Department of Medical Parasitology, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | | | - Mahmoud Soliman
- Department of Pathology and Clinical Pathology, Faculty of Veterinary Medicine, Assiut University, Assiut 71515, Egypt
- Department of Immunology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA
| | - Sultan S Al-Thagfan
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Al Madinah Al Munawarah 30001, Saudi Arabia
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Salimi M, Assar S, Mohamadzadeh D, Kanjorpor A. Acute respiratory distress syndrome after spontaneous rupture of a large pulmonary hydatid cyst in a 17-year-old male: A case report. Clin Case Rep 2023; 11:e7194. [PMID: 37064739 PMCID: PMC10098424 DOI: 10.1002/ccr3.7194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/17/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Pulmonary hydatid cysts (PHC) and their complications are still a health concern in endemic countries. Here we described a 17-year-old male presented with a large PHC with a spontaneous rupture. He developed acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. He was treated with albendazole, broad-spectrum antibiotics, and corticosteroids. The patient's general condition did not allow any attempt for surgical resection of the cyst. He was discharged in stable condition after one month and referred to a thoracic surgeon for resection of the cyst. As far as we know ARDS after hydatid cyst rupture was rarely reported, and through this case report we aimed to raise awareness of this possible life-threatening complication.
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Affiliation(s)
- Mehdi Salimi
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Shirin Assar
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Dena Mohamadzadeh
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
| | - Asal Kanjorpor
- Clinical Research Development Center, Imam Reza HospitalKermanshah University of Medical SciencesKermanshahIran
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Lungu M, Oprea VD, Zaharia AL, Stan B, Rebegea L, Mocanu DI, Elkan EM, Niculet E, Croitoru A. Stroke-Associating Acute Limb Ischemia Due to the Rupture of a Hydatid Cyst. Curr Issues Mol Biol 2023; 45:2597-2608. [PMID: 36975540 PMCID: PMC10047644 DOI: 10.3390/cimb45030170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
(1) Background: Hydatidosis, or human cystic echinococcosis, is a zoonotic disease. Endemic in some areas, recently it has an increasing incidence in wider regions, determined by population migration. Clinical features depend on the localization and level of infection: asymptomatic or with signs related to hypersensitivity, organic functional deficiencies, expanding mass effects, cyst infection and sudden death. In rare cases, the rupture of a hydatid cyst causes emboli formation by the residual laminated membrane. (2) Methods: We performed an extensive literature review, starting from the case of a 25-year-old patient presenting with neurologic symptoms relevant for acute stroke, associating right upper limb ischemia. (3) Results: Imaging investigations revealed the source of the emboli as the rupture of a hydatid cyst, the patient presenting multiple pericardial and mediastinal localizations. Cerebral imaging confirmed an acute left occipital ischemic lesion, with complete recovery of the neurological deficit after therapy, while surgery for acute brachial artery ischemia had a favorable postoperative evolution. Specific anthelmintic therapy was initiated. An extensive literature review using available databases revealed the scarcity of data on embolism as a consequence of cyst rupture, highlighting the significant risk of clinicians overlooking this possible etiology. (4) Conclusions: An associated allergic reaction should raise the hypothesis of a hydatid cyst rupture as a cause of any level acute ischemic lesion.
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Affiliation(s)
- Mihaela Lungu
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Violeta Diana Oprea
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Andrei Lucian Zaharia
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Bianca Stan
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Laura Rebegea
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Dan Iulian Mocanu
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Eva Maria Elkan
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
- "St. Joan" Pediatric Clinical Emergency Hospital Galati, 800487 Galati, Romania
| | - Elena Niculet
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
| | - Ana Croitoru
- "St. Apostle Andrei" Clinical Emergency County Hospital Galati, 800578 Galati, Romania
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, 800216 Galati, Romania
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Rao VM, Joel RK, Benjamin SR, Adhikari T, Jennifer L. Aspergilloma in a hydatid cavity. Indian J Thorac Cardiovasc Surg 2022; 38:659-662. [PMID: 36258823 PMCID: PMC9569403 DOI: 10.1007/s12055-022-01391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Fungal colonization by aspergillus usually occurs in pre-existing lung cavities mostly due to post-tubercular sequelae. Colonization of a hydatid cavity is very rare. We hereby report this unusual co-infection in a 55 years old diabetic male patient who was diagnosed pre-operatively and was managed with surgery, anti-fungal agents, and anthelminthics. The possibility of this co-infection should make clinicians more vigilant in managing hydatid cysts in diabetics and immunocompromised, as they may have concomitant fungal infestation of the hydatid cavity.
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Affiliation(s)
- Vinay Murahari Rao
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Raj Kumar Joel
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Santhosh Regini Benjamin
- The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Twisha Adhikari
- The Department of General Pathology, The Christian Medical College, Vellore, Tamil Nadu India 632004
| | - Lydia Jennifer
- The Department of Clinical Microbiology, The Christian Medical College, Vellore, Tamil Nadu India 632004
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Abstract
Echinococcosis is a worldwide public health problem causing considerable paediatric morbidity and mortality in endemic areas. The presentation of cystic echinococcosis (CE) varies by age. Unlike adults, where hepatic involvement is common, pulmonary CE is the dominant site in the paediatric population. Pulmonary cysts are typically first seen on chest X-ray, either as an incidental finding or following respiratory symptoms after cyst rupture or secondary infection of the cyst. In children, pulmonary cysts have a broad differential diagnosis, and a definitive diagnosis relies on the combination of imaging, serology, and histology. In countries with high infectious burdens from diseases such as acquired immunodeficiency syndrome (AIDS) and tuberculosis (TB), the diagnosis is additionally challenging, as atypical infections are more common than in developed countries. Pulmonary CE is treated with a combination of surgery and chemotherapy.
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Solari L, Agrafiotis AC, Lardinois I. VATS approach for pulmonary sclerosing pneumocytoma: a case report. Acta Chir Belg 2022; 122:123-126. [PMID: 32397805 DOI: 10.1080/00015458.2020.1765671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pulmonary Sclerosing Pneumocytoma (PSP) is a rare type of benign lung tumor usually encountered in middle-aged Asian women. The lesion is mostly found on routine chest x-rays. Though surgery is recognized as the recommended treatment, there is no consensus on the standard operative procedure for this tumor. CASE PRESENTATION We report a case of a 48 year-old Caucasian woman who presented with a right para-hilar mass mimicking a hydatid cyst. After an unsuccessful initial treatment with oral Albendazole, and a steady growth over 10 years, the patient was programmed for surgical resection by video-thoracoscopic (VATS) approach. We were able to completely resect the tumor by VATS. Histopathological analysis suggested the diagnosis of Pulmonary Sclerosing Pneumocytoma. No further treatment was required and the patient was rapidly discharged. CONCLUSIONS Pulmonary sclerosing pneumocytoma is a rare form of benign tumor that should be part of the differential diagnosis of lung lesions of unknown origin. Because of its well-defined encapsulated structure allowing total enucleation, VATS can be proposed as a less invasive alternative to classic thoracotomy.
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Affiliation(s)
- Livio Solari
- Department of Thoracic Surgery, CHU St Pierre, Brussels, Belgium
| | | | - Ines Lardinois
- Department of Thoracic Surgery, CHU St Pierre, Brussels, Belgium
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Perineal and right femoral hydatid cyst in a female with regional paresthesia: a rare case report. BMC Surg 2022; 22:64. [PMID: 35197047 PMCID: PMC8867753 DOI: 10.1186/s12893-022-01516-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Hydatid cyst is a zoonotic disease caused by the parasite Echinococcus granulosus. The tapeworm larvae can create cyst in different areas of the body, especially the liver and lungs; however, the formation of the cyst in the perineal and femoral regions are very rare. The unusual location of the cyst can help us with the differential diagnosis of soft tissue mass(es) in this location, especially in endemic areas. Diagnosis of this disease is crucial because if the cysts are ruptured during surgery, the fluid inside can cause anaphylactic shock. Case presentation Our case is a 55-year-old woman with the chief complaint of a painful mass in the right thigh and perineal area with progressed pain and paresthesia to the right thigh and shin. The patient had no history of fever, abdominal pain, digestive dysfunctions, or chest pain. The vital signs were normal, and there was no family history. Physical examination showed that the skin over the mass had no discoloration, and the size was around 5.7 cm long. The result of the ultrasonography examination showed a cystic mass with suspicion toward the femoral hernia. After a CT scan, the result of secondary workups was a multi-lobular cystic mass with no connection to the abdominal region, which suggested a hydatid cyst. The patient underwent spinal anesthesia and surgery, a cystic mass with ecto- and endocyst, with clinical similarity to a hydatid cyst, was removed with wide margins, and the cyst wall was kept intact. In the next step, the specimen was sent for histological examination that confirmed cystic hydatidosis. The Post-surgical Abdominal and thoracic Ultrasonography screening were used to exclude relapse, and medical therapy was given for 3–6 months. An 18-months follow-up demonstrated no reoccurrence and no newly formed cyst. Conclusions Although rare, femoral hydatid cyst can occur in some cases, especially in endemic areas. We highly recommend our colleagues consider ruling out cystic hydatidosis in any patients complaining of regional mass(es), mostly painless, presenting with adjacent tissue compression with or without manifestation of an allergic reaction.
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Khalfallah I, Hajjej S, Ferchichi M, Boussetta A, Affes M, Louhaichi S, Hamdi B, Ammar J, Hamzaoui A. Giant pulmonary hydatid cyst in children. Monaldi Arch Chest Dis 2021; 92. [PMID: 34523320 DOI: 10.4081/monaldi.2021.1770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022] Open
Abstract
Hydatid disease is still endemic in Tunisia. It is mostly seen in young people less than 40 years and children are affected in one third of cases. The lungs are the predominant location in children. Our study aims to define the particularities of children PHC's (pulmonary hydatic cyst) management, the characteristics of giant cyst and to study predictive factors of complications. We included retrospectively 105 children with PHC followed between 1999 and 2019. Patients were aged less than 16 years with surgically confirmed diagnosis of PHC. Two groups of cysts were defined: giant cysts which were 10 cm across or more, and no giant cysts.The sex-ratio was 1,38 with a mean age of 10.5±3 years. The symptomatology was dominated by cough (59%), thoracic pain (51%) and hemoptysis (46%). Giant cysts were observed in 24 (22.9%) patients. Dyspnea (29% vs 5% p<0.001) and thoracic pain (88% vs .41% p<0.001) were significantly more frequently reported in giant cysts. Eighty-six patients had a single cyst (83%) and 19 had multiple cysts (17%). Giant cysts accounted for 22,9% (24 cases). Thoracic ultrasonography was diagnostic in 77.4%. The thoracic CT scan was performed in 27 children with inaccessible cysts in thoracic ultrasonography or in diagnostic doubt.Patients were all treated surgically. Surgical procedures consisted of cystectomy (59%), pericystectomy (18%) and pulmonary resection when parenchyma was destroyed (23%). Parenchymal resection was more often performed in complicated cysts (27% vs 20% p>0.05) and in giant cysts (41% vs 18% p<0.05). A two-stage thoracotomy was performed in the 4 patients with bilateral cysts. Thirteen patients presented immediate post-operative complications which occurred more frequently in complicated and giant cysts. Hospital stay was longer in complicated cysts (16±9 days vs 7±3 days; p<0.001) and in giant cysts (14±9 days vs 11±8 days; p>0.05). In endemic regions, the diagnosis of PHC in children should be based on the combination of thoracic radiography and ultrasonography which are effective, not costly, safe and accessible. Complicated and giant PHC cause lung damage leading to extensive parenchymal resection. They are more associated with post-operative complications prolonging hospital stay and increasing expenses.
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Affiliation(s)
- Ikbel Khalfallah
- Pulmonology B Department, Abderrahmen Mami Hospital, Ariana; Faculty of Medicine, El Manar University, Tunis.
| | - Sabri Hajjej
- Pulmonology B Department, Abderrahmen Mami Hospital, Ariana; Faculty of Medicine, El Manar University, Tunis.
| | - Meriem Ferchichi
- Pulmonology B Department, Abderrahmen Mami Hospital, Ariana; Faculty of Medicine, El Manar University, Tunis.
| | - Abir Boussetta
- Faculty of Medicine, El Manar University, Tunis; Pediatric Department, Charles Nicolle Hospital, Tunis .
| | - Meriam Affes
- Faculty of Medicine, El Manar University, Tunis; Radiology Department, Abderrahmen Mami hospital, Ariana.
| | - Sabrine Louhaichi
- Pulmonology B Department, Abderrahmen Mami Hospital, Ariana; Faculty of Medicine, El Manar University, Tunis.
| | - Besma Hamdi
- Pulmonology B Department, Abderrahmen Mami Hospital, Ariana; Faculty of Medicine, El Manar University, Tunis.
| | - Jamel Ammar
- Pulmonology B Department, Abderrahmen Mami Hospital, Ariana; Faculty of Medicine, El Manar University, Tunis.
| | - Agnès Hamzaoui
- Pulmonology B Department, Abderrahmen Mami Hospital, Ariana; Faculty of Medicine, El Manar University, Tunis.
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Anaphylactic shock due to ruptured pulmonary hydatid cyst in a young patient from Iran. Ann Med Surg (Lond) 2021; 68:102675. [PMID: 34401139 PMCID: PMC8358647 DOI: 10.1016/j.amsu.2021.102675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction and importance: Hydatidosis is a zoonotic condition caused by contact with the tapeworm Echinococcus granulosus metacestode. The liver and lungs are the most prominent locations for cysts. This is a rare case of pulmonary hydatid cyst (PHC) rupture in a young woman following a severe cough. Case presentation On July 9, 2018, a 20-year-old woman presented to our hospital in northern Iran with a complaint of cough with excessive sputum, dyspnea, drooling, symptoms of nausea and vomiting, itching and urticarial. Imaging findings showed evidence of a large, space-occupying mass in the right lung. She underwent a thoracoscopic wedge resection (TWR) as a minimally invasive technique, to remove the wall and contents of the cyst. Also, anaphylactic shock occurred in the patient. Due to hemodynamic disorders and heart and respiratory failure, unfortunately, the patient expired. Clinical discussion The rupture of a hydatid cyst may result in irreversible damage. PHC rupture is a serious complication that causes excessive coughing and chest pain. A rupture into the pleural or pericardial cavity is a serious and potentially fatal disease. Conclusion Anaphylactic shock should be considered as one of the serious complications of PHC, particularly in young ones. Therefore, early diagnosis and appropriate treatment are essential to prevent severe complications such as anaphylactic shock. Anaphylactic shock due to ruptured pulmonary hydatid cyst in a young patient from Iran. Radiography and CT scan showed evidence of a large, space-occupying mass in the right lung. Early diagnosis and appropriate treatment are essential to prevent severe complications such as anaphylactic shock.
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A rare case of numerous hydatid cysts in the pleural cavity without extrapleural involvement. Ann Med Surg (Lond) 2021; 65:102290. [PMID: 33948168 PMCID: PMC8079935 DOI: 10.1016/j.amsu.2021.102290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance: The Echinococcus Granulosus, an endemic parasite in several parts of the world which causes hydatid disease. Human acts as an intermediate host and gets infected by eating parasitic eggs. As it is well known, lungs and liver are the most commonly involved organs in this disease. When the pleura is involved, it is almost always secondary to a ruptured primary lung cyst. Case presentation The purpose of this paper is to present a case of 16-year-old male with complaints of dyspnoea and dry cough for 6 months. His vital signs, CBC, and laboratory tests were all within normal. Chest X-ray showed a complete opacification of hemithorax. Clinical discussion CT revealed multiple cysts filling up the whole pleural cavity with collapsed lung and to-left mediastinal shift. The patient was diagnosed with primary pleural hydatidosis. The treatment was surgical, followed by parasitic medications. During the surgery, surgeons were able to simply extract many cysts by hand and eventually the collapsed lung returns to its normal volume and normal functional state. The patient was indicated to continue with Albendazole for 1 year after surgery. Three days after the surgery, chest X-ray was within normal. Conclusion Primary pleural hydatidosis is such a rare case to present as full filled up pleural cavity and a complete opacification of hemithorax on CXR. Using the developed technical methods helped to confirm such case and in choosing the best surgical intervention. The result was satisfactory with fully expanded and functional lung. Primary pleural hydatidosis is an extremely rare clinical entity. Liver and lungs are the most common locations for primary cysts. Hydatid disease could be asymptomatic or present with nonspecific symptoms. Surgery is the main treatment for hydatid disease, followed by oral medications. Prognosis is excellent in hydatid disease after surgery.
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Lane A, Wright H. Hydatid disease, hepatic injury and hypertonic saline: a clinical conundrum. BMJ Case Rep 2021; 14:14/1/e238390. [PMID: 33462022 PMCID: PMC7816914 DOI: 10.1136/bcr-2020-238390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Echinococcosis or human hydatid disease is a helminthic infection is caused by Echinococcus species. Classically, cystic echinococcosis is caused by Echinococcus granulosus sensu stricto, E. equinus, E. ortleppi and E. canadensis, though several other species have been implicated in hydatid disease. Echinococcus infection may lead to cystic disease of the liver, lungs and potentially other organs. Here we present a patient who had cystic disease of the lungs and liver. The patient initially experienced right upper quadrant pain and nausea, and later went on to develop a fever, cough and dyspnoea in the setting of hydropneumothorax. CT scan of the chest and abdomen revealed a large fluid collection at the left lung base and a large lobular complex fluid mass within the right lobe of the liver. Echinococcus titres were positive. The patient was commenced on albendazole; however, experienced significant derangement of liver enzymes within the following month. In light of this, the albendazole was ceased, and a hemi-hepatectomy was performed. During the hemi-hepatectomy there was some cyst content spillage, and subsequently a washout with hypertonic saline 3% was performed. This was followed by a course of praziquantel 1200 mg two times per day for 14 days. Repeat CT 6 months later demonstrated no evidence of recurrence.
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Affiliation(s)
- Angus Lane
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia,Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Hugh Wright
- Department of Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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14
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Hamouri S, Odat H, Syaj S, Hecker E, Alrabadi N. Rupture of pulmonary hydatid cyst in pediatrics: A cross-sectional study. Ann Med Surg (Lond) 2021; 62:31-36. [PMID: 33489113 PMCID: PMC7808915 DOI: 10.1016/j.amsu.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/30/2020] [Accepted: 01/01/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Pulmonary hydatid cyst is a parasitic disease causing an endemic and a health burden in many regions. Lung cysts are more common than liver cysts in children and patients may remain asymptomatic. Cyst rupturing is not uncommon, and it is considered the most feared complication. In this cohort study, we aimed to identify the risk factors related to cyst rupture in a Jordanian pediatric population. Methods We retrospectively evaluated all pediatric patients who underwent cystostomy and capitonnage for pulmonary hydatid cyst between 2003 and 2020 at King Abdullah University Hospital. Results We found 43 patients with a mean age of 13 ± 4 years who suffered from 61 pulmonary cysts. 55.6% of them were males. The most prevalent symptom was shortness of breath. The rupture rate for patients was 39.5%, and 29.5% for cysts. None of the patients with cyst rupture had an anaphylactic reaction. The left lower lobe was the most common location for both intact and ruptured cysts. 25.6% of the patients had giant cysts (>10 cm) with a mean of 7.4 cm for all cysts. Patients with intact cysts had higher-rates of cough (42.3% vs. 29.4%) and lower-rates of shortness of breath (34.6% vs. 52.9%) than patients with ruptured cysts, which were not statistically significant. Although statistically insignificant, patients with ruptured cysts tended to have multiple cysts in one lung (29.4% vs. 7.7%, p = 0.180), and more complication rates (29.4% vs 7.7%, p = 0.09). Both groups had almost identical IgG-ELISA positive results. We found no significant association between cyst rupture and age, gender, presenting symptoms, cyst size, cyst location, and rate of postoperative complications. Conclusion The rupture of pulmonary hydatid cyst has clinical consequences in pediatric patients, further studies on larger populations are needed to identify factors that make patients more prone to rupture and prioritize them for clinical monitoring and management. Hydatid cyst rupture is a common serious complication in pediatrics with 39.5% of the diagnosed cases. About 25% of pediatric patients tend to develop giant cysts but the cyst size was not significantly associated with rupture. Pediatric patients with rupture pulmonary hydatid cyst have a low tendency to develop an anaphylactic reaction. Larger sample size is needed to define the risk factors and predictors of pulmonary hydatid cyst rupture.
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Affiliation(s)
- Shadi Hamouri
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Haitham Odat
- Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Sebawe Syaj
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Erich Hecker
- Thoracic Surgery Department, Thoracic Center Ruhrgebiet in Herne, University of Duisburg-Essen Teaching Hospital, Germany
| | - Nasr Alrabadi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Lupia T, Corcione S, Guerrera F, Costardi L, Ruffini E, Pinna SM, Rosa FGD. Pulmonary Echinococcosis or Lung Hydatidosis: A Narrative Review. Surg Infect (Larchmt) 2020; 22:485-495. [PMID: 33297827 DOI: 10.1089/sur.2020.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lung hydatidosis is a zoonosis related to infection by the Echinococcus tapeworm species. Lung involvement in this condition is second only to the liver echinococcosis. Diagnosis ordinarily results from an accidental finding in a direct chest radiograph evaluation because of the delayed growth of the cysts. Moreover, a consistent treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. In this review, we expect to sum up the main features of lung hydatidosis with a perspective on medical and surgical treatment. Methods: Cochrane Library and PubMed were the databases used to perform a narrative literature review. Search terms included "pulmonary echinococcosis" and "lung hydatidosis." The MeSH terms were "lung" [All Fields] AND {"echinococcosis" [MeSH Terms] OR ("hydatidosis" [All Fields] OR "pulmonary" [All Fields] AND "echinococcosis" [All Fields] OR "hydatidosis." A search period from September 1980 to May 2020 was chosen to compare studies from different decades, given the changes in pulmonary echinococcosis management. Results: A uniform treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. No clinical trials have analyzed and compared all the diverse treatment approaches. Cyst size, characteristics, position in the lung and clinical presentation, and the availability of medical/surgical expertise and equipment are the mainstays of echinococcosis management. When feasible, surgery is as yet the principal therapeutic choice to eliminate the cysts; anti-parasitic drugs may minimize complications during high-risk surgery or be used as definitive therapy in some instances with contraindications to surgery. Conclusions: Lung hydatidosis management must become less heterogeneous. We support treatment directed to the subject established on the clinical scenario, host factors, and surgical risk. Strict cooperation in this process between infectious disease specialists and surgeons may optimize best practices to help create shared practical guidelines to simplify clinicians' decision-making. Furthermore, we need a consensus for lung hydatidosis treatment and inserting this disease to global surgery agenda will have a positive impact on acquiring high-quality data that enables us to create an evidence-based guideline for this disease.
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Affiliation(s)
- Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco Guerrera
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Lorena Costardi
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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16
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Durhan G, Tan AA, Düzgün SA, Akkaya S, Arıyürek OM. Radiological manifestations of thoracic hydatid cysts: pulmonary and extrapulmonary findings. Insights Imaging 2020; 11:116. [PMID: 33175295 PMCID: PMC7658283 DOI: 10.1186/s13244-020-00916-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/30/2020] [Indexed: 11/27/2022] Open
Abstract
Hydatid cyst caused by the larval form of Echinococcus is a worldwide zoonosis. The lungs and liver are the most common sites involved. While the lung parenchyma is the most common site within the thorax, it may develop in any extrapulmonary region including the pleural cavity, fissures, mediastinum, heart, vascular structures, chest wall, and diaphragm. Imaging plays a pivotal role not only in the diagnosis of hydatid cyst, but also in the visualization of the extent of involvement and complications. The aim of this pictorial review was to comprehensively describe the imaging findings of thoracic hydatid cyst including pulmonary and very unusual extrapulmonary involvements. An outline is also given for the findings of complications and differential diagnosis of thoracic hydatid cyst.
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Affiliation(s)
- Gamze Durhan
- Department of Radiology, Hacettepe University Faculty of Medicine, 06410, Ankara, Turkey.
| | - Aziz Anıl Tan
- Department of Radiology, Hacettepe University Faculty of Medicine, 06410, Ankara, Turkey
| | - Selin Ardalı Düzgün
- Department of Radiology, Hacettepe University Faculty of Medicine, 06410, Ankara, Turkey
| | - Selçuk Akkaya
- Department of Radiology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Orhan Macit Arıyürek
- Department of Radiology, Hacettepe University Faculty of Medicine, 06410, Ankara, Turkey
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17
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Dogru MV, Sezen CB, Aker C, Erdogu V, Erduhan S, Cansever L, Metin M. Evaluating Giant Hydatid Cysts: Factors Affecting Mortality and Morbidity. Ann Thorac Cardiovasc Surg 2020; 27:164-168. [PMID: 33162437 PMCID: PMC8343032 DOI: 10.5761/atcs.oa.20-00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to evaluate the prognostic factors affecting morbidity and mortality among patients who underwent surgery for giant pulmonary hydatid cysts in our center. Methods: Data from 283 patients who underwent surgery in our center for pulmonary hydatid cyst between 2008 and 2018 were retrospectively analyzed. Cysts 10 cm in diameter or larger were considered giant hydatid cysts. Results: There were 145 women (51.2%) and 138 men (48.8%). Giant cyst (≥10 cm) was present in 57 patients (20.1%), while the other 226 patients (79.9%) had cysts smaller than 10 cm. Operations were performed using videothoracoscopic approach in 68 patients (24%) and with thoracotomy in 215 patients (76%). Hydatid cysts were on the left side in 129 patients (45.6%), on the right side in 143 patients (50.5%), and bilateral in 11 patients (3.9%). Postoperative morbidity occurred in 29 patients (10.2%). Use of videothoracoscopic surgical approach did not affect morbidity. The mortality rate within the first 90 days was 0.35% (n = 1). Conclusion: Giant cysts are more common in the young age group than in older adults. Regardless of cyst size, surgery should be performed as soon as possible after diagnosis to avoid potential complications.
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Affiliation(s)
- Mustafa Vedat Dogru
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Celal Bugra Sezen
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cemal Aker
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Volkan Erdogu
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Erduhan
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Levent Cansever
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muzaffer Metin
- Department of Thoracic Surgery, University of Health Sciences Turkey, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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18
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Lodhia J, Chugulu S, Sadiq A, Msuya D, Mremi A. Giant isolated hydatid lung cyst: two case reports. J Med Case Rep 2020; 14:200. [PMID: 33097083 PMCID: PMC7585214 DOI: 10.1186/s13256-020-02524-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Echinococcosis is a parasitic disease caused by Echinococcus granulosus and causes cystic lesions in the liver and lungs commonly. It is endemic in many parts of the world, and though humans are incidental hosts of the parasite, the disease can have severe consequences. CASE PRESENTATION We present two patients from pastoralist (Maasai) communities in rural Tanzania with long-standing chest pain accompanied by hemoptysis. Both were managed surgically after diagnosis, but one patient died of the complications following rapture of the cyst during surgery. Histopathological evaluation of the specimens confirmed the diagnosis of giant hydatid cysts. CONCLUSION Animal-keeping communities such as the Maasai are at risk of echinococcosis because of their close proximity to animals. The diagnosis can be made on the basis of history and radiological as well as laboratory findings. Surgery is a recommended mode of treatment, though it carries a high risk, especially when the cyst ruptures. Primary preventive measures are thus necessary in order to avoid the secondary and tertiary complications of the management of giant hydatid cysts, which is difficult in resource-limited endemic areas.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania.
| | - Samwel Chugulu
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, P. O. Box 2240, Moshi, Tanzania
| | - Adnan Sadiq
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania.,Department of Radiology, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, P. O. Box 2240, Moshi, Tanzania
| | - Alex Mremi
- Kilimanjaro Christian Medical University College, P. O. Box 2240, Moshi, Tanzania.,Department of Pathology, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Tanzania
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19
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Successful Management of a Huge Pulmonary Hydatid Cyst with Lung-Preserving Surgery. Case Rep Surg 2020; 2020:9526406. [PMID: 32257501 PMCID: PMC7103054 DOI: 10.1155/2020/9526406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/29/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
The lung is the second most commonly involved organ in humans by hydatid disease. Management of large pulmonary hydatid cysts is a great challenge for thoracic surgeons. Lung resections should be considered the last choice for huge pulmonary hydatid cysts when the lung expansion is not optimal after cyst removal. Here, we present a case of huge lung hydatid cyst involving the entire right lower lobe which was successfully managed by lung-preserving surgery in which the postoperative course showed gradual resolution of the involved lobe during a one-year follow-up.
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20
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Abstract
Infectious diseases are one of the main causes of morbidity and mortality worldwide. With new pathogens continuously emerging, known infectious diseases reemerging, increasing microbial resistance to antimicrobial agents, global environmental change, ease of world travel, and an increasing immunosuppressed population, recognition of infectious diseases plays an ever-important role in surgical pathology. This becomes particularly significant in cases where infectious disease is not suspected clinically and the initial diagnostic workup fails to include samples for culture. As such, it is not uncommon that a lung biopsy becomes the only material available in the diagnostic process of an infectious disease. Once the infectious nature of the pathological process is established, careful search for the causative agent is advised. This can often be achieved by examination of the hematoxylin and eosin-stained sections alone as many organisms or their cytopathic effects are visible on routine staining. However, ancillary studies such as histochemical stains, immunohistochemistry, in situ hybridization, or molecular techniques may be needed to identify the organism in tissue sections or for further characterization, such as speciation.
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Affiliation(s)
- Annikka Weissferdt
- Associate Professor, Department of Pathology, Division of Pathology and Laboratory Medicinec, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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21
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Armoon A, Mehrian P, Soleimantabar H, Torabi S, Ghahderijani BH. Computer Tomography (CT) Characteristics of Pulmonary Cystic Echinococcosis. Med Arch 2019; 73:338-343. [PMID: 31819308 PMCID: PMC6885213 DOI: 10.5455/medarh.2019.73.338-343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/15/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Cystic echinococcosis (CE) is a common zoonosis worldwide. The two most frequent location of CE are liver and lung. Confirmatory diagnosis of CE is routinely performed sung imaging methods such as computer aided tomography and nuclear magnetic resonance in humans. AIM to investigate CT scan imaging of patients with pulmonary CE in Masih Daneshvari Hospital from 2011 to 2017. MATARIAL AND METHODS This descriptive-analytic study was carried out on patients with pulmonary CE referring to Masih Daneshvari Hospital. By using the convenience sampling, 195 cases were selected from eligible patients. The data collection tool was a researcher-made questionnaire that included demographic, clinical and laboratory information. Data were analyzed using SPSS software version 20. RESULTS In this study, 84.1% and 15.9% of patients were diagnosed using surgical method and CT scan, respectively. Our findings indicated CE was most commonly located in liver (28.2%) and spleen was considered as the lowest location (3.1%). Furthermore, cough was the most common clinical symptom of patients. The lower right lobe opacity was found to be higher, while and Lingula was the least frequent. CONCLUSION According to the findings of this study, surgery is the most important diagnostic and cough method as the most common clinical symptom of the disease. Since the CE with atypical symptoms is relatively common, physicians should always consider the lung CE in differential diagnosis of localized radiological images.
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Affiliation(s)
- Aida Armoon
- Department of Radiology, Emam-Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Mehrian
- Radiology, Telemedicine Research Center (TRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, The Islamic Republic of Iran
| | - Hussein Soleimantabar
- Department of Radiology, Emam-Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Torabi
- Department of Radiology, Emam-Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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22
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Rawat S, Kumar R, Raja J, Singh RS, Thingnam SKS. Pulmonary hydatid cyst: Review of literature. J Family Med Prim Care 2019; 8:2774-2778. [PMID: 31681642 PMCID: PMC6820383 DOI: 10.4103/jfmpc.jfmpc_624_19] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022] Open
Abstract
Echinococcosis is a rare infectious disease in human being that occurs by the larval stages of taeniid cestodes of the genus Echinococcus. Human cystic echinococcosis is the most common presentation. The liver is the most common site of echinococcal cyst, followed by the lungs. The symptoms of lung infestation lead to sudden onset of chest pain, cough, fever, and hemoptysis after a cyst rupture. The diagnosis is confirmed by radiology supplemented with serology. Chest X-ray and computer tomography of chest is the principal investigation for pulmonary hydatid cyst (PHC). The treatment of PHCs is either pharmacotherapy and/or surgery. Surgical intervention is the most preferred treatment of choice; pharmacotherapy is useful in selected patients. Pharmacotherapy includes oral administration of benzimidazoles group of drugs like mebendazole or albendazole.
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Affiliation(s)
- Sanjib Rawat
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Kumar
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rana Sandip Singh
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Kumar Singh Thingnam
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Balta C. Uniportal-Single Incision Thoracoscopic Access for Pulmonary Hydatid Cysts. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190508090653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:
Pulmonary hydatid cyst is caused by Echinococcus Species and has high
prevalence in low and middle income countries. Surgery remains the gold standard method for this
parasitic pulmonary disease. Here, we report 20 cases of pulmonary hydatid cysts that underwent
minimally invasive videothoracoscopic surgery.
Methodology:
All the patients who underwent minimally invasive complete thoracoscopic removal
of pulmonary hydatid cysts in our clinic, which were recorded in the hospital database had been
extracted. Clinical properties and complications of the surgeries were analyzed retrospectively.
Results:
Minimally invasive method was performed in all 20 cases. The mean duration of operation
was 95 minutes (min-max: 45-175), and the mean length of hospitalization was 3.55 days (min-max:
2-7). The complication rate was 15% (n=3) and there was no recurrence in 6 months of follow- up.
Conclusion:
Videothorascopic pulmonary hydatid cysts removal seems to be a safe and useful
method. This method is applied in all suitable patients with pulmonary hydatid cysts.
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Affiliation(s)
- Cenk Balta
- Department of Thoracic Surgery, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
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24
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The diagnostic value of fiberoptic bronchoscopy in ruptured lung hydatid cysts. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:350-354. [PMID: 32082883 DOI: 10.5606/tgkdc.dergisi.2019.17479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/19/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the diagnostic yield of fiberoptic bronchoscopy in ruptured pulmonary hydatid cysts indistinguishable from pulmonary masses on imaging techniques. Methods Between January 2000 and January 2018, a total of 45 consecutive patients (27 males, 18 females; mean age 46.4±13.5 years; range, 23 to 78 years) who underwent fiberoptic bronchoscopy to establish the definitive diagnosis following radio-diagnostic procedures were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, preoperative diagnostic studies, bronchoscopic findings, and postoperative diagnosis were recorded. Results Endobronchial hyperemia (n=42) and purulent secretion (n=34) are the most common findings of bronchoscopy. The most specific finding was the presence of pieces of cystic membranes in 23 patients. Scolices were seen in five patients in bronchial aspirate. In one patient, both pieces of cystic membranes and scolices in bronchial aspirate were detected. The preliminary diagnosis of a hydatid cyst was made based on these findings in 28 patients (62.2%) preoperatively. The definitive diagnosis of a hydatid cyst was confirmed through thoracotomy in all patients. Conclusion Bronchoscopy is a particularly valuable method in the definitive diagnosis of ruptured lung hydatid cysts. The definite diagnosis is based on the visualization of the endobronchial membrane during bronchoscopy or scolices in the bronchial aspirate. It can be also used to prevent complications such as bronchial dissemination and asphyxia due to intra-bronchial membrane pieces.
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A giant cystic echinococcosis of the lung in East Turkey. Ann Med Surg (Lond) 2018; 36:51-53. [PMID: 30377526 PMCID: PMC6202798 DOI: 10.1016/j.amsu.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Hydatid cyst disease is a zoonosis provoked by Echinoccocus. Presentation of case 17 year old male applied to our clinic with complaints of fatigue, lassitude, right chest pain and spitting of watery expectoration proceeding in 6 months. Computed tomographic scan indicated a 130*110 mm smooth contoured cavitary lesion located in the right middle lobe of the lung. Treatment with cystotomy and capitonnage successfully. Histopathologic examination confirmed hydatid cyst. The patient recovered from all his complaints postoperatively and he was discharged from the hospital in 7 days. Albendazole was implemented for 3 months postoperatively. He was observed to be healthy in his three month follow-up visit. Discussion Pulmonary hydatid cysts are generally treated with surgery. Cystotomy and capitonnage, pericystectomy and enucleation are the commonly used surgical techniques. Conclusions Surgery is the treatment regimen for pulmonary hydatid cysts and antihelmintic therapy is adviced to eliminate recurrences postoperatively. Hydatid disease is an endemic disease provoked by Echinococcus granulosus. Preoperative diagnosis of hydatid cyst is assured with clinical, radiological and serological outcomes. Cystotomy and capitonnage, enucleation and pericystectomy are the commonly used surgical techniques.
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Iqbal N, Hussain M, Idress R, Irfan M. Disseminated hydatid cyst of liver and lung. BMJ Case Rep 2017; 2017:bcr-2017-222808. [PMID: 29184009 DOI: 10.1136/bcr-2017-222808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Hydatid cyst commonly affects liver followed by lung, but rarely affects both organs simultaneously. Here we presented a patient who presented with concurrent involvement of both lungs and liver. Patient presented with dyspnoea and generalised weakness with bilateral rounded opacities throughout the lung field of variable sizes. CT scan chest with contrast showed multiple rounded soft tissue density in both lungs and liver. Patient underwent mini thoracotomy which revealed multiple cystic lesions throughout lung. ELISA for anti-Echinococcus antibodies shows positive titres. Due to extensive involvement, patient was started on medical treatment albendazole. The patient showed significant improvement both clinically and radiographically on treatment. Thus long-term medical treatment helps in such cases where surgery is not possible.
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Affiliation(s)
- Nousheen Iqbal
- Department of Medicine, section of Pulmonology and critical care, Aga Khan Hospital, Karachi, Pakistan
| | | | - Romana Idress
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Muhammad Irfan
- Department of Medicine, Section of Pulmonology and Critical care, Aga Khan University and Hospital, Karachi, Pakistan
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A Potentially Fatal Error in Diagnosis of a Pulmonary Hydatid Cyst. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2017. [DOI: 10.5812/archcid.57296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gun E, Etit D, Buyuktalanci DO, Cakalagaoglu F. Unusual locations of hydatid disease: A 10-year experience from a tertiary reference center in Western Turkey. Ann Diagn Pathol 2017; 29:37-40. [PMID: 28807340 DOI: 10.1016/j.anndiagpath.2017.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/24/2016] [Accepted: 01/20/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hydatid disease is an endemic parasitic infection caused by Echinococcus granulosus mostly seen in the Mediterranean countries. The most affected organ is the liver, however hydatidosis can be found anywhere in the human body. METHODS The records of patients who were diagnosed with hydatid disease in our hospital from December 2005 to February 2016 were analyzed retrospectively. The cases were evaluated and recorded depending on their gender, age and the localization of the cysts. RESULTS A total of 329 patients diagnosed over a 10-year period were included in our study. There were 202 females (61.4%) and 127 males (38.6%). The hydatid cysts were located in the liver in 257 (78.1%) patients and in unusual locations in 72 (21.9%) patients. The most common unusual site for hydatid cysts was the spleen followed by bones, central nervous system, soft tissue, the kidney and the gall bladder. Amongst these 72 patients who had hydatid cysts in unusual locations; 33 patients had concomitant liver hydatidosis, whereas 39 patients had primary involvement of unusual sites. Two patients with malignancies also had hydatid cysts in different locations. CONCLUSION Hydatid disease affects many organs in the body and therefore it can pose a major diagnostic dilemma and it may mimic other entities. In endemic areas, a differential diagnosis of hydatid disease should be considered for cystic masses in any anatomical location.
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Affiliation(s)
- Eylul Gun
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basin Sitesi, 35360 Karabaglar, Izmir, Turkey.
| | - Demet Etit
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basin Sitesi, 35360 Karabaglar, Izmir, Turkey
| | - Dilara O Buyuktalanci
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basin Sitesi, 35360 Karabaglar, Izmir, Turkey
| | - Fulya Cakalagaoglu
- Department of Pathology, Izmir Katip Celebi University, Ataturk Training and Research Hospital, Basin Sitesi, 35360 Karabaglar, Izmir, Turkey
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Zamani A, Yosunkaya S. Intact endobronchial hydatid cyst: an unexpected bronchoscopic challenge. Asian Cardiovasc Thorac Ann 2017; 26:60-62. [PMID: 28403624 DOI: 10.1177/0218492317705287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a rare case of intact endobronchial hydatid cyst that posed a diagnostic challenge because of an unusual imaging manifestation (atelectasis) and unexpected bronchoscopic findings. Although the role of bronchoscopy in the management of pulmonary hydatid cyst is still controversial, 6 cases of complicated pulmonary hydatid cyst removed completely by suction through a fiberoptic bronchoscope have been reported so far. To the best of our knowledge, this is the first nonsurgically treated case of intact endobronchial hydatid cyst with an uneventful long-term follow-up.
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Affiliation(s)
- Adil Zamani
- Department of Pulmonary Medicine, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Sebnem Yosunkaya
- Department of Pulmonary Medicine, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Engström ELS, Salih GN, Wiese L. Seronegative, complicated hydatid cyst of the lung: A case report. Respir Med Case Rep 2017; 21:96-98. [PMID: 28443235 PMCID: PMC5392770 DOI: 10.1016/j.rmcr.2017.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/05/2017] [Accepted: 04/06/2017] [Indexed: 11/24/2022] Open
Abstract
Cystic echinococcosis (CE) is an important helminthic zoonotic disease that commonly affects the liver and lungs. Imaging methods and serology establish the diagnosis in most cases. Chest x-ray can diagnose uncomplicated pulmonary hydatid cysts, whereas superinfection and/or rupture of the hydatid cyst (complicated cysts) may change the radiographic appearance and lead to delayed diagnosis and treatment. We report the case of a patient with hemoptysis and chest pain, where computer tomography scan of the lung suggested a large, ruptured hydatid cyst. However, serological tests with indirect hemagglutination (IHA)for Echinococcus granulosus antibodies were negative, and there was massive growth of Streptococcus pneumoniae in sputum. Based on this, we concluded that the patient had a bacterial lung abscess. The diagnosis of CE was only made after surgical removal of the cyst followed by microscopy and polymerase chain reaction.
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Affiliation(s)
| | - Goran Nadir Salih
- Department of Internal Medicine, Division of Respiratory Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lothar Wiese
- Department of Internal Medicine, Division of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
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Kern P, Menezes da Silva A, Akhan O, Müllhaupt B, Vizcaychipi KA, Budke C, Vuitton DA. The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease. ADVANCES IN PARASITOLOGY 2017; 96:259-369. [PMID: 28212790 DOI: 10.1016/bs.apar.2016.09.006] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.
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Affiliation(s)
- P Kern
- University Hospital of Ulm, Ulm, Germany
| | | | - O Akhan
- Hacettepe University, Ankara, Turkey
| | - B Müllhaupt
- University Hospital of Zurich, Zürich, Switzerland
| | - K A Vizcaychipi
- National Institute of Infectious Diseases, Buenos Aires, Argentina
| | - C Budke
- Texas A&M University, College Station, TX, United States
| | - D A Vuitton
- Université de Franche-Comté, Besançon, France
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Ruptured pulmonary hydatid cyst: a case report. J Parasit Dis 2017; 41:899-902. [PMID: 28848299 DOI: 10.1007/s12639-017-0880-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022] Open
Abstract
Ruptured pulmonary hydatid cyst (PHC) is an important clinical problem in endemic areas to echinococcal infection. Herein we present a rare case of ruptured PHC in an adolescent boy that was misdiagnosed as pulmonary tuberculosis in local health center. When sputum specimen was stained by acid-fast staining for detection of Mycobacterium tuberculosis, hooklets of Echinococcus granulosus were observed. A simple chest X-ray showed a multilobulated mass in the lower part of the left lung. Computed tomography scan verified existence of thick walled caviar lesion with irregular air-fluid level. The diagnosis was confirmed at the time of surgery. Misdiagnoses of PHC may even lead to irreparable damages. Therefore, accurate diagnosis is necessary to prevent severe complications.
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Conservative Surgical Management for Pulmonary Hydatid Cyst: Analysis and Outcome of 148 Cases. Can Respir J 2016; 2016:8473070. [PMID: 27642249 PMCID: PMC5013219 DOI: 10.1155/2016/8473070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 07/10/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
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.
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Garg MK, Sharma M, Gulati A, Gorsi U, Aggarwal AN, Agarwal R, Khandelwal N. Imaging in pulmonary hydatid cysts. World J Radiol 2016; 8:581-587. [PMID: 27358685 PMCID: PMC4919757 DOI: 10.4329/wjr.v8.i6.581] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/23/2015] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored.
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Abstract
Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the larval stages of the cestode Echinococcus granulosus. Worldwide, pulmonary hydatid cyst is a significant problem medically, socially, and economically. Surgery is the definitive therapy of pulmonary hydatidosis. Benzimidazoles may be considered in patients with a surgical contraindication. This review will focus on pathogenesis, lifecycle, clinical features, and management of pulmonary hydatid disease.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajnish Pathania
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Anupam Jhobta
- Department of Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Babu Ram Thakur
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajesh Chopra
- Department of Cardiac and Thoracic Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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36
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Helminthosis and eosinophilia in Spain (1990-2015). Enferm Infecc Microbiol Clin 2016; 36:120-136. [PMID: 26827134 DOI: 10.1016/j.eimc.2015.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 12/16/2022]
Abstract
The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations.
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Çobanoğlu U, Aşker S, Mergan D, Sayır F, Bilici S, Melek M. Diagnostic Dilemma in Hydatid Cysts: Tumor-Mimicking Hydatid Cysts. Turk Thorac J 2015; 16:180-184. [PMID: 29404100 DOI: 10.5152/ttd.2015.4606] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 03/27/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Hydatid cysts are sometimes confused with different pathologies, and problems arise in their diagnosis and treatment. In this study, cases that are followed up with a diagnosis of lung malignancy and that are detected to have hydatid cysts were retrospectively examined. MATERIAL AND METHODS Seven patients with hydatid cysts whose clinical and radiological features were consistent with lung malignancy were retrospectively examined between 2010 and 2014 regarding sex, age, symptoms, diagnostic methods, surgical procedures performed, and postoperative complications. In the diagnosis of the patients, radiological diagnostic methods such as chest radiography, thoracic computed tomography (TCT), and positron emission tomography+computed tomography (PET-CT) as well as invasive diagnostic methods such as bronchoscopy, fine-needle aspiration biopsy, thoracentesis, and video-assisted thoracoscopic surgery were used. RESULTS The average diameter of the lesions was determined as 4.14±1.57 cm in TCT. Maximum standardized uptake value (SUV max) was measured as 8.77±3.41 (5.4-15.1) in the PET-CT analysis. Bronchoscopy, fine-needle aspiration biopsy, and thoracentesis yielded no results. Definitive diagnosis was established by performing thoracotomy and video-assisted thoracoscopic surgery. CONCLUSION Pulmonary hydatid cysts can appear as malignant diseases such as lung cancer as well as infectious pathologies such as tuberculosis or benign pathologies. Radiologically, it should be kept in mind that pulmonary hydatid cysts can mimic many pulmonary pathologies, particularly malignancies. Necessary examinations towards its differential diagnosis must be performed in the preoperative period.
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Affiliation(s)
- Ufuk Çobanoğlu
- Department of Chest Surgery, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Selvi Aşker
- Department of Chest Diseases, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Duygu Mergan
- Department of Chest Surgery, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Fuat Sayır
- Department of Chest Surgery, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Salim Bilici
- Department of Pediatric Surgery, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Mehmet Melek
- Department of Pediatric Surgery, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
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Abstract
Background: Hydatid disease is caused by the larval stage of Echinococcus. Liver is the most commonly involved organ followed by the lungs. Pulmonary hydatidosis can be primary or secondary. The disease may be asymptomatic for several years. Cause of concern is the fatal anaphylaxis, which may be life threatening. Materials and Methods: The present retrospective study is over a period of ten years (2003-2012). The demographic data including the clinical features, radiological findings, other organ involvement, surgical and medical management done and histopathological findings were compiled from the records. Results: During the study period a total of eight cases, five male and three female, with age ranging from eight to 43 years were diagnosed as pulmonary hydatid disease. Five patients had presented with complicated cysts. Six patients had solitary cysts involving the lung while bilateral lung involvement was seen in two cases. One patient had multiple pulmonary cysts. Three patients had associated cysts in liver and two in spleen. Surgical lobectomy was done in four cases. Histopathology showed acellular laminated ectocysts in all the cases, whereas endocyst with brood capsules was seen in five cases. Conclusions: Pulmonary hydatidosis is not uncommon. Anaphylaxis, although rarely seen, may be a disastrous event. High index of clinical suspicion and mass awareness for interruption of transmission of parasite can lead to proper treatment and possible eradication.
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Affiliation(s)
- Rajpal Singh Punia
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Reetu Kundu
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Usha Dalal
- Department of General Surgery, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Uma Handa
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
| | - Harsh Mohan
- Department of Pathology, Government Medical College and Hospital, Chandigarh, Punjab and Haryana, India
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Singh U, Kumar S, Gour H, Singh N, Ramaraj M, Mittal V, Jhim D. Complicated hydatid cyst and "air bubble" sign: a stepping-stone to correct diagnosis. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:20-4. [PMID: 25612057 PMCID: PMC4307737 DOI: 10.12659/ajcr.892621] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hydatid cyst, or Echinococcosis, is an important helminthic zoonotic disease in humans that commonly affects the liver and lungs. Uncomplicated hydatid cysts, seen as round opaque lesions on chest radiography, are easily diagnosed, whereas complicated cysts (infected and or perforated) may change the radiographic appearance of the hydatid cyst, causing an incorrect diagnosis and delayed treatment. Although in radiology many signs have been described, the "air bubble" sign, seen in the mediastinal window of CECT as a single or multiple small rounded radiolucent areas with sharp margins within the periphery of a solid mass lesion, is being recognized as a sign with high sensitivity and specificity in the diagnosis of complicated hydatid cysts. CASE REPORT A 32-year-old female on anti-tubercular treatment for the past 3 months without any improvement was admitted to our hospital. CECT of the chest revealed a mass-like lesion with the "air bubble" sign. After 15 days the patient had a vigorous bout of coughing, leading to expectoration of pieces of whitish yellowish gelatinous membrane for the next 3 days. The ELISA result for Echinococcus was highly positive. On the basis of the "air bubble" sign, positive serology, and expectorated pieces of the membrane, the patient was diagnosed as having a complicated hydatid cyst. CONCLUSIONS Due to the varied presentations of complicated hydatid cyst, the knowledge and awareness of various signs in radiology associated with the hydatid cyst, in particular the "air bubble" sign, is imperative in making a prompt and accurate diagnosis of a complicated hydatid cyst.
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Affiliation(s)
- Urvinderpal Singh
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Sunil Kumar
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Hitesh Gour
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Navdeep Singh
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Murlidharan Ramaraj
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Vidhu Mittal
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
| | - Daksh Jhim
- Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India
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Sadrizadeh A, Haghi SZ, Masuom SHF, Bagheri R, Dalouee MN. Evaluation of the effect of pulmonary hydatid cyst location on the surgical technique approaches. Lung India 2014; 31:361-5. [PMID: 25378844 PMCID: PMC4220318 DOI: 10.4103/0970-2113.142118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: A hydatid cyst is the most common lung parasitic disease and is endemic in Iran. A hydatid cyst is more common in the right lung and lower lobes. Objective: The aim of this study was to assess surgical treatment of pulmonary hydatid cysts and whether the location of cyst affects surgical technique approaches. Materials and Methods: This study was performed on 87 patients with a pulmonary hydatid cyst who were referred to Qaem Hospital from 2010 to 2012. Selection of surgical technique was according to size, location, and the number of cysts. Patients were divided into two groups: (1) surgery with preserving lung parenchyma and (2) lobectomy. Afterward, the relationship between the location of cyst and surgical technique approaches was evaluated. Data was analyzed by Chi-square and Fisher exact tests. Results: In this study, no significant relation was found between the size (P = 0.682) and number (P = 0.344) of cysts and lobectomy necessity. But, there was a significant relation between the occurrence of cyst in middle lobe and lobectomy necessity (P = 0.016). Conclusions: According to the results, type of surgical technique does not depend on the size and number of cysts, but it may be related to the location of the cyst and the ratio of lung destruction.
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Affiliation(s)
- Ali Sadrizadeh
- Department of Thoracic-Surgery, Cardio Thoracic Surgery and Transplant Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ziaollah Haghi
- Department of Thoracic-Surgery, Cardio Thoracic Surgery and Transplant Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Hossein Fattahi Masuom
- Department of Thoracic Surgery, Endoscopic and Minimal Invasive Surgery Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Bagheri
- Department of Thoracic-Surgery, Cardio Thoracic Surgery and Transplant Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marziyeh Nouri Dalouee
- Department of Thoracic-Surgery, Cardio Thoracic Surgery and Transplant Research Center, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Reiterová K, Auer H, Altintaś N, Yolasigmaz A. Evaluation of purified antigen fraction in the immunodiagnosis of cystic echinococcosis. Parasitol Res 2014; 113:2861-7. [PMID: 24828349 DOI: 10.1007/s00436-014-3947-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/05/2014] [Indexed: 12/13/2022]
Abstract
Echinococcus granulosus antigen B fraction (AgB) was evaluated for its prognostic value in the serological follow-up of cystic echinococcosis (CE), compared to crude hydatid fluid (HF) as well as soluble somatic Echinococcus multilocularis antigen (Em). The sensitivity and specificity of enzyme-linked immunosorbent assays (ELISA) were compared examining 177 sera from patients with different clinical courses and outcome of CE and with other parasitic infections. AgB-ELISA in comparison to confirmed cystic echinococcosis has 96.4% sensitivity and 97.2% specificity, with 93.1% positive predictive value and 98.6% negative predictive value. The HF-ELISA was more sensitive than the AgB-ELISA, but its specificity was lower. Our results indicate that AgB-ELISA was more satisfactory for seroconfirmation of acute echinococcosis than HF-ELISA. Moreover, the AgB-ELISA has a potential key role in control measures implemented in patients undergoing surgery. In sera of patients more than 3 months after the treatment, no antibody response to antigen B was detected; however, with conventionally used HF-ELISA, they were still positive. The AgB is recommended for the confirmatory diagnosis. AgB-WB allocated low background with typical "triplet" bands at 8-12-16 kDa.
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Affiliation(s)
- Katarína Reiterová
- Institute of Parasitology of the Slovak Academy of Sciences, Hlinkova 3, 040 01, Košice, Slovak Republic,
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Leuzzi G, Cesario A, Lococo F, Inchingolo R, Petrone G, Inzani F, Congedo MT, Corbo GM, Valente S, Granone P. A 43-year-old man with persistent fever and sudden shortness of breath. Chest 2013; 144:1066-1071. [PMID: 24008959 DOI: 10.1378/chest.12-2075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Alfredo Cesario
- Department of Thoracic Surgery, Catholic University, Rome; IRCCS San Raffaele Pisana, Rome
| | - Filippo Lococo
- Department of Thoracic Surgery, Arcispedale Santa Maria Nuova, IRCCS Reggio Emilia, Reggio Emilia, Italy
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Khelil MB, Allouche M, Banasr A, Gloulou F, Benzarti A, Zhioua M, Haouet S, Hamdoun M. Sudden death due to hydatid disease: a six-year study in the northern part of Tunisia. J Forensic Sci 2013; 58:1163-1170. [PMID: 23822140 DOI: 10.1111/1556-4029.12172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 06/14/2012] [Accepted: 07/01/2012] [Indexed: 11/27/2022]
Abstract
Human ecchinococcosis also known as hydatid disease is a zoonotic infection caused by the tapeworm Ecchinococcus with 2-3 Million cases worldwide. We hereby report a 6 years period study of Sudden death due to hydatidosis aiming to analyze the epidemiological criteria, death circumstances, and autopsy observations attributed to hydatid disease. During the past 6 years, 26 death cases were due to hydatid disease. Our analysis shows that the sex ratio (M/F) was 1.6, the mean age was 31-year old, and 65% of the subjects lived in rural places. In 17 cases, death occurred in the victim's place, five victims died after a heavy exercise, and in two cases, death occurred immediately after trauma. At autopsy, 91% of the cysts were found in the liver. In three cases, death followed a septic state, and in two cases, it followed an acute respiratory failure. Death was attributed to anaphylaxis in 17 cases.
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Affiliation(s)
- Mehdi Ben Khelil
- Service de Médecine Légale de Tunis, Hôpital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
| | - Mohamed Allouche
- Service de Médecine Légale de Tunis, Hôpital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
| | - Ahmed Banasr
- Service de Médecine Légale de Tunis, Hôpital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
| | - Fatma Gloulou
- Service de Médecine Légale de Tunis, Hôpital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
| | - Anis Benzarti
- Service de Médecine Légale de Tunis, Hôpital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
| | - Mongi Zhioua
- Service de Médecine Légale de Tunis, Hôpital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
| | - Slim Haouet
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
- Service d'Anatomie Pathologique, Hôpital La Rabta, Tunis, 1007, Tunisia
| | - Moncef Hamdoun
- Service de Médecine Légale de Tunis, Hôpital Charles Nicolle, 138 Boulevard du 9 avril 1938, Tunis, 1006, Tunisia
- Université de Tunis El Manar, Faculté de Médecine de Tunis, Tunis, 1007, Tunisia
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Golzari SEJ, Sokouti M, Ghaffari A, Bazzazi AM, Ghabili K. Ultrasonography in diagnosis of pulmonary hydatid cysts. THE LANCET. INFECTIOUS DISEASES 2013; 13:294. [PMID: 23538222 DOI: 10.1016/s1473-3099(13)70070-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Hidatidosis mediastínica secundaria. Arch Bronconeumol 2013; 49:87-8. [DOI: 10.1016/j.arbres.2012.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 09/04/2012] [Accepted: 09/08/2012] [Indexed: 11/24/2022]
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46
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Kuzucu A, Ulutas H, Reha Celik M, Yekeler E. Hydatid cysts of the lung: lesion size in relation to clinical presentation and therapeutic approach. Surg Today 2013; 44:131-6. [DOI: 10.1007/s00595-012-0484-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 11/04/2012] [Indexed: 10/27/2022]
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47
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El Khattabi W, Aichane A, Riah A, Jabri H, Afif H, Bouayad Z. [Imaging of hydatid cyst of the lung]. REVUE DE PNEUMOLOGIE CLINIQUE 2012; 68:329-337. [PMID: 23117113 DOI: 10.1016/j.pneumo.2012.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/08/2012] [Indexed: 06/01/2023]
Abstract
The pulmonary hydatid cyst is frequent in Mediterranean countries such as Morocco. Our analytic study concerned 70 cases of lung hydatid cysts collected from 2007 to 2010. Mean age was 35years and we noted a male predominance (53%). Forty-seven percent of patients belong to rural environment where 64% of them were in contact with dogs. The respiratory symptomatology was made mostly by cough (86%) and chest pain (70%). Diagnosis was based on radioclinical arguments with positive hydatic serology in some cases. The cyst was single in 84% of the cases, safe in 55% of the cases. The location in the right lung was dominant with a major affection of the right lower lobe. Conventional surgery was indicated in 67 cases. The liver hydatid cyst was discovered in 20% of cases and treated at the same time phases in 71% of cases. The evolution was good in 73% of the cases and marked by a recurrence in three of the operated cases.
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Affiliation(s)
- W El Khattabi
- Service des maladies respiratoires, hôpital, 20 Août, CHU Ibn Rochd, Casablanca, Maroc.
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48
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Lazović B. PULMONARY ECHINOCOCCOSIS - CASE REPORT. ACTA MEDICA MEDIANAE 2012. [DOI: 10.5633/amm.2012.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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49
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Yaldiz S, Gursoy S, Ucvet A, Yaldiz D, Kaya S. Capitonnage Results in Low Postoperative Morbidity in the Surgical Treatment of Pulmonary Echinococcosis. Ann Thorac Surg 2012; 93:962-6. [DOI: 10.1016/j.athoracsur.2011.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/04/2011] [Accepted: 11/07/2011] [Indexed: 11/25/2022]
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50
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Durgun Yetim T, Basoglu A, Taslak Sengul A, Yetim I, Serdar Bekdemir O, Hokelek M. Comparison of the protoscolocidal effectiveness of hypertonic saline, povidone-iodine and albendazole solutions in an experimental lung hydatid cyst model. J Int Med Res 2012; 39:1230-8. [PMID: 21986125 DOI: 10.1177/147323001103900411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Secondary hydatidosis is an important problem encountered during the surgical treatment of hydatid cysts. This study describes an experimental model of secondary hydatidosis by cyst inoculation, used to explore whether simultaneous inoculation of protoscolocidal agents could prevent secondary hydatidosis. Fertile cyst fluid was injected into the pleural space of rabbits alone (group 1, n = 8), and in combination with 2% albendazole solution (group 2, n = 8), 20% hypertonic saline (group 3, n = 8) or 10% povidone-iodine (group 4, n = 8). Computed tomography imaging of the thorax, indirect haemagglutination (IHA) titres and eosinophil counts were used to determine cyst development. After 16 months, three control rabbits had pneumothorax, seven had cysts and four had parenchymal nodules. Histopathological investigation of nodules revealed 87.5% cyst formation. Pleural thickening was observed in rabbits from all groups. Cyst formation rates, IHA titres and eosinophilia counts were higher in group 1 than in groups 2-4. This study demonstrated the experimental formation of secondary hydatidosis and found that topical protoscolocidal agents were beneficial in preventing cyst recurrence.
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Affiliation(s)
- T Durgun Yetim
- Department of Thoracic Surgery, Mustafa Kemal University School of Medicine, Antioch, Turkey.
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