Parenchyma-Preserving Surgery in the Management of Pulmonary Hydatid Cysts

Surgical treatment of pulmonary hydatid disease: a nine-year single-center experience

INTRODUCTION

Hydatidosis is one of the most critical parasitic zoonotic diseases worldwide. Lungs are the second most common site of the disease.

Seronegative Bilateral Pulmonary Hydatid Cysts in a 15-Year-Old Boy From Pakistan: Report of a Rare Case

Hydatid disease, attributed to the tapeworm Echinococcus granulosus, poses a significant health threat in regions where it is endemic. Here, we present a case involving a 15-year-old boy from rural Pakistan who initially sought medical attention due to a persistent cough and hemoptysis. Despite initially testing negative for serological markers, imaging studies revealed well-defined cysts in both lungs. Confirmation of the diagnosis was achieved through histopathological examination. Management includes albendazole therapy and surgical excision of the cyst. Our case underscores the diagnostic challenges associated with seronegative cases and underscores the importance of considering hydatid disease in endemic regions, irrespective of typical serological markers. This report enhances understanding regarding the clinical presentation, diagnostic approach, and management strategies for pulmonary hydatid cysts.

Hospital-based retrospective analysis of 224 surgical cases of lung hydatid cyst from southern Iran

BACKGROUND

The lungs are considered the second-most frequent location for hydatid cyst in human. The current retrospective hospital-based study aimed to assess the epidemiological data, clinical presentation, and treatment outcomes of lung hydatid cyst in patients who underwent surgery for this disease in Fars province, southern Iran.

METHODS

In this retrospective study, hospital records of 224 pulmonary hydatid cyst patients were assessed in two main university-affiliated hospitals in Fars Province, southern Iran. Clinical features of patients, epidemiological data, cyst features, surgical interventions, and treatment outcomes were reviewed and analyzed.

RESULTS

A total of 224 hydatid cyst cases of the lung were reviewed. Male patients accounted for the majority of cases (60.4%). The average age of the patients was 31.13 (± 19.6), ranging from 2 to 94 years old. Of the 224 patients, 145 (75.9%) cases had only one single cyst and mostly 110 (53.9%) located in the right lung. Also, 6 (2.9%) cases had cysts in both lungs. The lower lobe of the lungs was the most common location of the hydatid cyst. The average size of lung hydatid cyst was 7.37 cm (SD = 3.86; rang: 2-24) while for the cyst areas was 42.87cm² (SD = 52.76; range: 2-488). Regarding the surgical method, 86 (38.6%) cases were operated by lung resection surgery while 137 (61.4%) cases had lung preserving one. The chief complaints of the patients were cough (55.4%) and dyspnea (32.6%). Relapse was documented in 25 (11.16%) of cases.

CONCLUSIONS

Lung hydatid cyst is a common infection in southern Iran. Lung preserving surgery is the method of choice for the management of hydatid cyst. Relapse, which was not uncommon in our study, is a challenging feature of hydatid cyst management.

Basic Operative Tactics for Pulmonary Echinococcosis in the Era of Endostaplers and Energy Devices

Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species Echinococcus. The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed.

Clinical presentation and outcome of children with hydatid disease: a retrospective cross-sectional study from a tertiary care hospital in eastern India

Clinical presentation of echinococcosis in paediatric population is varied and depends on the site of involvement. The present study was planned to analyse the clinical presentations and therapeutic options for management of echinococcosis in children admitted to a tertiary care hospital. Medical records of children with echinococcosis was reviewed retrospectively over a period of 3 year and 6 months. Demographic data, clinical presentation, management and outcome data were collected and analysed. During the study period, 14 children with hydatid disease were admitted to the hospital. The frequency was higher in male (71.4%) compared to females (28.6%). Liver was found to be the commonest site for hydatid cyst with 78% of all cases had hydatid cyst localised to liver. In half of all cases liver was the only site of involvement. Both liver and lung were involved in 21.4% cases and one patient (7.1%) had pelvic hydatid cyst in addition to liver involvement. Two patients (14.3%) had only pulmonary involvement and one (7.1%) patient had a hydatid cyst in common bile duct. Right upper abdominal pain was the most common presentation (78.5%) with cyst in liver. Cough, breathing difficulty, jaundice was observed in 28.5%, 21.4% and 7.1% of all patients respectively. All children were managed with a combination of surgical and medical therapy. Right upper abdominal pain and chronic cough were the common clinical presentation of hydatid cyst with hepatic and pulmonary involvement respectively. Presence of such chronic symptoms would raise the clinical suspicion of hydatid disease in endemic regions.

Morbidity and Mortality Risk Factors for Lung Hydatidosis Surgery: Over 30 Years' Experience Review

BACKGROUND

Lung hydatidosis (LH) is still an endemic pathology. Different published surgical series have reported variable numbers of patients, but few have studied the morbidity and mortality -associated risk-factors.

METHODS

Through a retrospective with a descriptive and analytical-aim-study, carried out from January 1987 to December 2020, we reported all operated cases for LH regardless of their locations, numbers, and aspects. We excluded non-operated patients, patients with extra-pulmonary hydatidosis, and those with a cystic pathology other than LH.

RESULTS

1169 patients were operated-on for LH with a total of 1288 interventions and a median age of 20 years (2-89 years). The total cyst number was 1951 with a median of 1 cyst (1-37) and a median size of 60mm (10-250mm). Forty per cent were complicated. Conservative surgery was performed on the majority of patients and anatomical resection was required in 23 patients (1.8%). Median number of bronchial fistulas was 3 (0-16). Decortication was necessary for 94 patients (7.3%). Morbidity and mortality rates were respectively 25% and 0.4%. Fever, pleural effusion and associated decortication were correlated morbidity and mortality risk-factors. Other morbidity factors were identified: non- protection of the surgical field, a cyst size ≥ 55mm, and a number of bronchial fistulas ≥3. Mortality factors were determined such as post-operative occurrence of septic shock, hemorrhage, and respiratory distress.

CONCLUSIONS

The earlier we operate-on LH patients (before complications set-in), and identify the different associated risk factors, the better the prognosis of curative surgery is.

Capitonnage method selection in pulmonary hydatidosis with purse-string or interrupted suture

Background

Disfigurements in the lung parenchyma due to capitonnage methods may lead to long-term atelectasis. The aim of the present study was to examine whether there are any complication differences between the capitonnage applied via interrupted suture or purse-string suture.

Method

Of the total of 120 cases that underwent hydatid cyst surgery during 2007 and 2020, those that were subject to capitonnage were included in the study. The preoperative and postoperative findings were analyzed for 76 cases subject to purse-string capitonnage (Group I) and 24 interrupted capitonnage (Group II).

Results

While the number of cases with complication in Group I was 16 (21.1%), there were only 2 (8.3%) complications in Group II; however, the difference was not statistically significant (P = 0.23). Bronchopleural fistula (n = 1) and prolonged air leak (n = 2) were observed in Group I, there was no bronchopleural fistula or prolonged air leak in Group II. Atelectasis was the most frequently observed complication observed in 12 (15.8%) cases in Group I and 2 (8.3%) cases in Group II (P = 0.53). The duration of hospitalization was lower for the patients in Group II. The number of days was 7.3 ± 2.7 for Group I and 5.3 ± 2.1 for Group II (P < 0.01).

Conclusion

This study is the first to compare whether there are any complication differences between the capitonnage methods via interrupted suture or purse-string suture. The results of the study put forth that the duration of hospitalization is lower in the interrupted capitonnage group. Parenchymal anatomy may be preserved better in interrupted capitonnage method.

Pulmonary Echinococcosis or Lung Hydatidosis: A Narrative Review

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.

[Management of massive hemoptysis secondary to pulmonary hydatidosis: Special features]

INTRODUCTION

Massive hemoptysis is a rare but serious presentation of pulmonary hydatid cysts. The literature reporting this clinical phenomenon is limited to sporadic cases.

MATERIAL AND METHODS

We undertook a retrospective study considering patients who had undergone lung surgery because of hydatid cyst from January 2000 o December 2015 and examined features associated with massive hemoptysis.

RESULTS

Among 270 patients operated on for lung hydatidosis, 13 (4.8%) had experienced massive hemoptysis. This sub group had an average age of 24±12 years (13-60 years) and a sex ratio of 0.85. Preoperative embolization was attempted in 5 patients but failed in all cases. All patients with massive hemoptysis were operated on emergency. The origin of bleeding was determined and controlled in all cases (from a vein or an artery from the pulmonary circulation). Pulmonary re-expansion was satisfactory after obliteration of the residual cavity and no pulmonary resection was necessary. The postoperative course was uneventful in 11 patients. Prolonged air-leak beyond 7 days was noted in two patients but settled subsequently with simple follow-up. Average postoperative follow-up was 32 months (8-63 months). One patient (who had hydatid vomit with massive hemoptysis) developed controlateral hydatid recurrence that was also successfully operated on. No recurrence of hemoptysis was noted during the follow-up period for all patients.

CONCLUSION

Massive haemoptysis secondary to pulmonary hydatidosis may be life-threatening. Surgery of hydatid cysts associated with direct vascular control of eroded vessels is sufficient to control hemoptysis.

Computer Tomography (CT) Characteristics of Pulmonary Cystic Echinococcosis

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.

Pulmonary hydatid cyst: Review of literature

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.

Surgery for Pulmonary Hydatidosis in Turkey in 2014: A Nationwide Study

OBJECTIVES

Turkey remains among the countries where hydatid disease is endemic. In this study, it was aimed to determine the number of operations performed for the treatment of pulmonary hydatid disease in Turkey during 2014 and to present the distribution of these operations according to the different regions of the country.

MATERIALS AND METHODS

The Turkish Thoracic Society Thoracic Surgery Study Group connected with the thoracic surgeons in each city through telephone. A data set was sent by email. The age, sex, contact with animals that might be a risk of gaining the hydatid disease, the side of the disease, the type of surgical method, other organ involvement were recorded and collected from each data set to form the final data, and the results were evaluated. Turkey comprises of 81 cities that are grouped in seven different regions. The number of operations was calculated for each city and region to present the distribution.

RESULTS

Overall, 101 centers from 81 cities were considered in the study. A total of 715 pulmonary hydatid cyst operations were performed in 690 patients during the study period. The most common operation technique was cystotomy and capitonnage through thoracotomy (76%). The highest incidence rate of operated patients was in the Eastern Anatolian Region (2.15 patients per 100 000 person-years).

CONCLUSION

Pulmonary hydatid disease still has a high incidence rate particularly in the southeast and east of Turkey, which are mainly rural areas and where stockbreeding is very common. Cystotomy and capitonnage is still the most common surgical method used to treat pulmonary hydatid cysts. Preventive methods should be performed strictly in these cities and regions to decrease the risk of infection.

Cystic pulmonary hydatidosis

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.

In Vitro Lung Model Assessing the Efficacy of Surgical Sealants in Treating Alveolar Air Leaks

PURPOSE

The lack of reliable testing methods limits the evidence-based practice of surgical sealants in treating alveolar air leak (AAL). We developed an in vitro lung model to evaluate sealants' efficacy and tested the widely used human thrombin-fibrinogen sponge, TachoSil as an example.

MATERIALS AND METHODS

The caudal lobe of freshly excised swine lung (n = 10) was intubated and ventilated. A focal superficial parenchymal defect (40 × 25 mm) was created in the inflated lung. AAL was assessed with increasing inspired tidal volume (TVi). After sealant application, AAL was assessed in the same way until burst failure, defined as an AAL exceeding 20 mL. To evaluate the elasticity of the sealant, the length of defect was recorded in the inflated lung.

RESULTS

Superficial parenchymal defects resulted in AAL increasing with ascending TVi. Multiple linear regression analysis revealed strong correlation between AAL and maximal inspiratory pressure, compliance and resistance. At TVi = 400, 500, and 600 mL, TachoSil achieved sealing in ten, eight, and seven tests, respectively. As TVi increased, superficial defects were still sealed in four, two, and two tests at TVi = 700, 800, and 900 mL, respectively. The burst pressure was 42 ± 5 cmH2O. Adhesive failures were found at the burst pressure in all tests. Concerning elasticity, TachoSil allowed an expansion of the covered lung defect of 7 ± 6 mm.

CONCLUSIONS

TachoSil demonstrated a strong sealing efficiency and marked elasticity in treating AAL. These results are consistent to that of the previously published animal experiment, suggesting the reliability of the presented in vitro model.

Parasitic pneumonia and lung involvement

Parasitic infestations demonstrated a decline in the past decade as a result of better hygiene practices and improved socioeconomic conditions. Nevertheless, global immigration, increased numbers of the immunocompromised people, international traveling, global warming, and rapid urbanization of the cities have increased the susceptibility of the world population to parasitic diseases. A number of new human parasites, such as Plasmodium knowlesi, in addition to many potential parasites, have urged the interest of scientific community. A broad spectrum of protozoal parasites frequently affects the respiratory system, particularly the lungs. The diagnosis of parasitic diseases of airway is challenging due to their wide varieties of clinical and roentgenographic presentations. So detailed interrogations of travel history to endemic areas are critical for clinicians or pulmonologists to manage this entity. The migrating adult worms can cause mechanical airway obstruction, while the larvae can cause airway inflammation. This paper provides a comprehensive review of both protozoal and helminthic infestations that affect the airway system, particularly the lungs, including clinical and roentgenographic presentations, diagnostic tests, and therapeutic approaches.

Saucerization: a modified uncapitonnage method of surgery for pulmonary hydatidosis

BACKGROUND

There are contrary opinions regarding the surgical treatment of pulmonary hydatid cysts. We report our experience performing a modified version of uncapitonnage surgery, called "saucerization," for treating pulmonary hydatid cysts.

METHODS

A total of 78 patients with pulmonary hydatid cysts were studied regarding their surgery outcome and the complication rate. The procedure used for cyst evacuation depended on whether the cyst had ruptured. If ruptured, cystotomy was done; otherwise, enucleation was preferred. To deal with the residual cavity in an uncapitonnage manner, we removed the thin margins of the pericyst and closed the bronchial openings at the cavity floor. All patients were followed up at least for 6 months.

RESULTS

The intensive care unit stay ranged from 1 to 9 days. Incomplete lung expansion (six patients) was the main postoperative complication followed by wound infection (four patients) and persistent air leak (≥7 days) (one patient). There was one death. Dependence on mechanical ventilation and subsequent septic shock were also observed. The other patients exhibited no complications during the follow-up period.

CONCLUSIONS

Our experience demonstrated a low complication rate associated with removing the thin margins of the residual cavity and changing the shape of it into a "saucer." The results were satisfactory and comparable to the results of other studies on pulmonary hydatid cysts.

Video-assisted thoracoscopic surgery to treat hydatid disease of the thorax in adults: is it feasible?

BACKGROUND

Optimal treatment of intrathoracic hydatid diseases in adults involves complete removal of the cyst with parenchyma-preserving surgery. In current practice, thoracotomy remains the standard surgical approach for pulmonary hydatid cysts, so surgical experience is limited, particularly with regard to video-assisted thoracoscopic surgery (VATS).

SUBJECTS AND METHODS

Between June 2007 and May 2011, a selected series of 12 adult patients presenting with intrathoracic hydatid cysts underwent VATS. The cysts were completely removed using a three-trocar technique.

RESULTS

Complete removal of the cysts was successful in all patients. All cysts were diagnosed by computerized tomography, and 6 (50%) patients had a history of hydatid disease in the liver or lung. No serious postoperative complications were observed. Patients with thoracoscopic excision were discharged after a median of 2.9 days (range, 2-6 days). No recurrences or complications were observed during a mean follow-up of 29 months.

CONCLUSIONS

Considering the conversion and complication rates in our series, VATS should be the primary therapeutic choice for adults with thoracic hydatid cysts. Open surgical interventions in patients with large and uncomplicated cysts appear optional.

A systematic review of the literature on cystic echinococcosis frequency worldwide and its associated clinical manifestations

A systematic literature review of cystic echinoccocosis (CE) frequency and symptoms was conducted. Studies without denominators, original data, or using one serological test were excluded. Random-effect log-binomial models were run for CE frequency and proportion of reported symptoms where appropriate. A total of 45 and 25 articles on CE frequency and symptoms met all inclusion criteria. Prevalence of CE ranged from 1% to 7% in community-based studies and incidence rates ranged from 0 to 32 cases per 100,000 in hospital-based studies. The CE prevalence was higher in females (Prevalence Proportion Ratio: 1.35 [95% Bayesian Credible Interval: 1.16-1.53]) and increased with age. The most common manifestations of hepatic and pulmonary CE were abdominal pain (57.3% [95% confidence interval [CI]: 37.3-76.1%]) and cough (51.3% [95% CI: 35.7-66.7%]), respectively. The results are limited by the small number of unbiased studies. Nonetheless, the age/gender prevalence differences could be used to inform future models of CE burden.

Surgical management for hydatid disease

Hydatid disease is caused by the parasite Echinococcus granulosus. The liver and the lungs are common sites. When a cystic lesion is seen on CT scan, diagnosis is made based on the patient having lived in an endemic area. Serologic tests are used for differential diagnosis. Medical treatment is centered on albendazole. Surgery is recommended either by open or endoscopic technique depending on the characteristics of the cysts and the patient. Complications of surgery are rare except for prolonged air leaks. Mortality occurs when the cyst is located in the central nervous system or occludes major vessels.

Pulmonary hydatid cyst: analysis of 1024 cases

PURPOSE

Pulmonary hydatid cyst, a parasitic disease, is a health care problem in developing countries. In this study, we evaluated outcomes of patients with pulmonary hydatid disease who were treated in our department.

METHODS

Patients admitted with a pulmonary hydatid cyst from 1981 to 2008 were enrolled in this study. Their demographic data, the sites and number of cysts, diagnostic methods, type of operation, outcomes, and recurrence rate were statistically analyzed.

RESULTS

Among the 1024 patients, the mean±SD age was 30.6±16.1 years, and the male/female ratio was 1.09. The most common symptom was a cough (55.1%). Only 1% of the patients were asymptomatic. Altogether, 53.8% had right-side involvement, 40.0% had left-side involvement, and 6.2% had bilateral disease. The inferior lobe was the lobe most common involved. The cyst was intact in 539 (52.6%) patients; and the others were complicated or perforated. The most common surgical technique entailed removing the cyst membrane without resecting the pericyst and closing the airways (67.2%). The cyst was enucleated in 21.2%; and parenchymal resection was performed in 10.3%. The mortality rate was 0.2%, and morbidity occurred in 8.4% of patients. The most common complications were residual spaces with prolonged air leak and wound infection. The recurrence rate was 2.5%, with most of the recurrences (82.6%) managed by surgery.

CONCLUSION

The best treatment for pulmonary hydatid cyst disease is surgery, which is associated with low mortality and morbidity rates. The most common and acceptable treatment is extraction of the cyst membrane without manipulating the pericyst and closure of small airways. Pulmonary resection should be reserved for complicated forms of the disease.

Unusual locations of hydatid disease: diagnostic and surgical management of a case series

BACKGROUND

Hydatid disease is endemic in many areas of the world, where it is an important public health problem. The aim of this study was to describe a series of patients with atypically located primary hydatid disease, accompanied by a literature review.

METHODS

Six male and four female patients with atypically located hydatid cysts who presented to the Kars State Hospital between September 2004 and March 2008 were evaluated. The mean age was 42.5 years (range 17-72 years). Hydatid cysts were identified by using a combination of serology tests, ultrasonography, and computed tomography (CT).

RESULTS

Six of the patients underwent surgical treatment. Three patients (two with pericardial hydatid involvement and one with pancreatic involvement) were sent to a tertiary medical center for surgery, and one patient died from cardiac and renal failure two days after diagnosis.

CONCLUSIONS

Although this disease is seen most often in the liver and lungs, it can be found in any part of the body. Hydatid disease must be considered in the differential diagnosis of cystic lesions, especially in patients who have spent time in endemic areas.

Pulmonary Hydatid Disease: Capitonnage is mandatory following Cystotomy

Pulmonary hydatid disease still remains an important healthcare problem. Conservative operative interventions including cystotomy or cystotomy with capitonnage are the two commonly used techniques. There is still significant controversy, however, over selection of these two procedures. In this retrospective analysis of 66 patients with hydatid disease, we employed three types of interventions, Group A, (n=5) cystotomy alone with closure of bronchial openings; Group B, (n=54) cystotomy with capitonnage and Group C, (n=7) lobectomy over a period of seven years in our patients and compared their postoperative outcome in terms of morbidity and mortality. Our data show that cystotomy with capitonnage is associated with low rates of postoperative prolonged air leak, bronchopleural fistula formation, empyema formation [mean complication rate 0.12% (Mean 0.08; 0.151- 95% CI)] as compared to cystotomy alone with closure of bronchial openings [mean complication rate 44% (Mean 2.20; 3.18- 95% CI)]. The lobectomy group was excluded from the comparison, as this approach is quite different from the cystostomy based enucleation techniques. We conclude that capitonnage with cystotomy may be a preferred procedure due to its lower rate of complications.

Surgical treatment of intrathoracic hydatid disease: a 5-year experience in an endemic region

PURPOSE

To present our recent surgical experience in treating patients with intrathoracic hydatidosis.

METHODS

This study reviewed the files of patients with pulmonary/intrathoracic extrapulmonary hydatid cysts treated surgically between 2003 and 2009. Demographic, laboratory and radiological data, clinical manifestations, site of the cyst, surgical approaches, and final outcome were noted and analyzed.

RESULTS

Forty patients underwent 42 operations (21 females, 19 males, mean age 36 years). Thirty-six patients (90%) had pulmonary (56.7% were intact/uncomplicated), three (7.5%) had intrathoracic extrapulmonary, and one (2.5%) had both pulmonary/intrathoracic extrapulmonary hydatid cysts. The right lung was involved in 64.9%. Larger pulmonary cysts ruptured more commonly (P = 0.007). Most patients (95%) were symptomatic, mostly dyspneic (72.5%). The mean forced expiratory volume in 1 s value was significantly reduced in cases with a large (P < 0.0001), or ruptured cyst (P = 0.05). The erythrocyte sedimentation rate was elevated in case of rupture (P = 0.05). A thoracotomy was performed for all patients. A cystotomy and capitonnage was performed more commonly than cystotomy without capitonnage for the pulmonary, and total excision was performed for the intrathoracic extrapulmonary hydatid cysts. The mortality was 0% and the morbidity was 17.5%. All patients received antihelminthic therapy postoperatively. There was no recurrence.

CONCLUSION

Surgery is considered to be the optimal treatment for intrathoracic hydatid disease. In addition, recurrence is very low when all such patients receive postoperative antihelminthic therapy.

Evaluation of pulmonary hydatid cyst cases

BACKGROUND

The incidence of pulmonary hydatid cyst has been high in developing countries such as Turkey.

OBJECTIVE

The aim of this study was to evaluate the clinical presentation, treatment and outcomes of pulmonary hydatid cyst disease at a tertiary centre.

METHODS

A total of 138 patients, aged between 9 and 72 years with pulmonary hydatid cyst were diagnosed between 2000 and 2008 in 2nd thoracic surgery clinic at our hospital. Clinical characteristics of patients, epidemiological features, cyst diameters and localizations, laboratory findings, surgical approaches were recorded and analyzed.

RESULTS

The most frequent symptoms of pulmonary hydatid cyst were chest pain and cough (44.9%, 37.6%). According to cyst size, there was no difference between younger than twenty and older age groups (p>0.05). Twenty-two patients had complicated cyst cases. Most of them were symptomatic (90.9%). Association of complicated cyst with hepato-pulmonary involvement was significantly higher as compared with single hydatid cyst (p=0.01). Cystectomy was performed in 84.05% of patients and post-operative mortality was seen in only one patient due to pulmonary embolism.

CONCLUSION

Association of lung and liver hydatid cyst increased the risk of occurrence of a complicated pulmonary hydatid cyst. Choice of surgical approach had satisfactory results and post-operative mortality was low.

Giant viable hydatid cyst of the lung: a case report

INTRODUCTION

Hydatid disease is a parasitic infestation caused by Echinococcus granulosus. The resulting large cysts in the lung are a special clinical entity called giant hydatid cysts.

CASE PRESENTATION

An 18-year-old Yemeni woman presented with a dry cough and mild fever, with no history of chest pain, dyspnoea or weight loss. Chest X-ray revealed a homogenous opacity almost replacing the right lung. The patient underwent surgery which revealed a large, viable hydatid cyst measuring 26 x 18 x 5 cm.

CONCLUSION

This case report provides evidence that non-complicated hydatid cysts, even if very large, have a good prognosis and can be safely treated by parenchyma-preserving surgery.

MANAGEMENT OF COMPLICATED HYDATID CYST OF THE THORAX

BACKGROUND

Complicated hydatid cyst of the thorax is important to the clinical approaches and treatment methods in hydatid disease. The aim of this study was to evaluate the problems of complicated pulmonary hydatid cyst, including choice of surgical methods, diagnostic clues and to discuss the inherent risks of medical therapy and the delay of surgical treatment in pulmonary hydatid disease.

METHODS

Between 2002 and 2006, 40 operations were carried out in 37 patients whose diagnoses were complicated hydatid cyst. The surgical approach was a posterolateral thoracotomy in all patients; a phrenotomy in two patients and a thoracoabdominal approach in one patient and two-stage bilateral thoracotomy in four patients. The preferred surgical treatment procedure was cystotomy and modified capitonnage, which was carried out in 26 patients (70%). Other procedures included a cystotomy in five (14%) and decortication in six (16%) patients. Segmentectomy was carried out in 1 (3%), and wedge resection in four patients (11%).

RESULTS

In 25 patients (67.5%), there were single hydatid cysts; whereas 12 patients (32.5%) had multiple cysts. Eleven patients had preoperative hydatid cyst history. Iatrogenic rupture of an intact hydatid cyst occurred in three patients. Extrathoracic involvement was apparent in 10 patients (27%). Intrathoracic but extrapulmonary involvement was apparent in six patients (16%). The morbidity ratio was 5%; there was prolonged air leak and atelectasis in one patient each. The mortality ratio was 3% (one patient). The average hospitalization duration for all patients was 5.7 days (range, 3-17 days). The mean follow up was 18.4 months with no recurrence.

CONCLUSION

Complicated hydatid cyst may have different clinical manifestations and may present radiologically as a primary lung tumour. In patients with suspicious lung masses owing to endemic area, history of a hydatid cyst or contralateral or extrathoracic hydatid cyst involvement at the same time should indicate a complicated pulmonary hydatid cyst. Preoperative anthelmintic therapy must be avoided owing to the risk of perforation. Treatment of a complicated hydatid cyst differs from that of an intact hydatid cyst. Anatomic resection may be necessary owing to destroyed lung tissue secondary to suppuration from a hydatid cyst; however, parenchymal preserving surgery is preferable in an uncomplicated hydatid cyst. A modified capitonnage method is recommended for complicated hydatid cyst treatment as it has a low morbidity rate.

Lung resections in children for congenital and acquired lesions

We reviewed a single-center experience of pediatric lung resections for various congenital and acquired benign lung conditions. Thirty-five children underwent lung resections between 1998 and 2006, their age ranging from 8 days to 12 years (mean 3 years), with a male:female ratio of 4:1. Twelve patients were neonates. Antenatal diagnosis was available in only one patient. The presenting symptoms were respiratory distress and respiratory tract infections. Imaging with chest X-ray with/without a CT scan picked up the lesion in all cases. Preoperative ventilation was required for five patients. One patient had pneumothorax at presentation; however, ten patients had inadvertent intercostal tube insertion before surgical referral. The surgical procedures performed included lobectomy (28), segmentectomy (3), and pneumonectomy in 4 cases. Twenty-one patients underwent emergency surgery. Six patients required postoperative ventilation. The histopathological diagnosis was congenital lobar emphysema (CLE) (9), congenital cystic adenomatoid malformation (CCAM) (9), bronchiectasis (9), sequestration (3), atelectasis (1), lung abscess (1), unilobar tuberculosis (1), hydatid cyst (1), and foreign body with collapse (1). There was considerable discrepancy between the preoperative diagnosis based on imaging and the postoperative histopathological diagnosis. Postoperative complications included atelectasis (2), pneumothorax (2) and fluid collection (4 cases). Three patients died, one from compromised cardiac function, one from overwhelming sepsis and one from respiratory failure due to severe bilateral CCAM; the rest of the patients made a satisfactory recovery. At short-term follow-up all patients were doing well. Pulmonary resections are necessary for various congenital and acquired lung lesions in children and can be done safely in a pediatric hospital setup. Proper preoperative diagnosis can avoid inadvertent intercostal tube insertion in patients with congenital cystic lung lesions. The histopathological diagnosis often differs from the radiological diagnosis. Emergency lobectomies for acute respiratory distress, even in neonates, result in a satisfactory outcome.

How to diagnose and manage common parasitic pneumonias

PURPOSE OF REVIEW

Parasitic pneumonia is being increasingly reported from many parts of the world due to globalization and travel across the continents. This review outlines the recent developments in the diagnosis and management of parasitic pneumonias.

RECENT FINDINGS

A polymerase chain reaction that can differentiate pathogenic Entamoeba histolytica from nonpathogenic species has been reported. It has been observed that pulmonary infection with Leishmania donovani can occur in immunodeficient and lung transplant patients. Acute respiratory distress syndrome, seen in severe falciparum malaria, has also been observed in vivax malaria. A study has demonstrated the return of chloroquine-sensitive falciparum malaria several years after chloroquine treatment was discontinued. Pulmonary hypertension has been reported in Schistosoma hematobium, S. mansoni and S. japonicum infections. Strongyloides hyperinfection and disseminated disease are frequently reported in immunocompromised individuals. Parenteral ivermectin is found to be useful in the treatment of disseminated strongyloidiasis. A chronic mild interstitial lung disease has been found to persist in tropical pulmonary eosinophilia despite treatment. Studies are in progress to develop vaccines against amoebiasis, malaria and hookworm infections.

SUMMARY

Parasitic pneumonia can sometimes be life threatening. If proper diagnosis is made early, the pneumonia can be treated successfully with currently available drugs.