Mediastinal hydatid cyst rupturing into the pleural cavity associated with pneumothorax: case report and review of the literature

Sudden death and hydatid cyst: A medicolegal study

The discovery of a hydatid cyst at autopsy poses the problem of its involvement in the mechanism of death. The aim of this study is to analyse the epidemiological and etiopathogenic characteristics of death attributed to hydatid disease, to discuss the mechanism of death and to propose preventive measures. This is a retrospective descriptive study of 26 cases of death with hydatid cyst autopsic discovered, collected at the forensic department of Fattouma Bourguiba University Hospital of Monastir (Tunisia) over a period of 27 years (from 1990 until 2017). In 26 cases, hydatid cyst was observed during autopsy of sudden death cases, which corresponds to 0.33% of the total of autopsies in this period. Of the 26 victims, 13 (50%) were men; the mean age was 43 years. Most victims were from rural zones (18 cases). In 20 cases, the complicated cyst was hepatic. It was cardiac in two cases. Of all cases, three cysts were cracked, and nine were broken. Of the 26 cases, only 15 were implicated in the death mechanism. Death was attributed to anaphylaxis in 12 cases, hydatid pulmonary embolism in 1 case, cardiac arythmia in one case and hemothorax in one case. Sudden death is the most dangerous complication of the hydatid cyst which can be discovered at autopsy. Several causes may explain its occurrence, the most common of which is anaphylactic shock.

A very rare case: Hydatid cyst surrounding uterus and magnetic resonance imaging findings in the pregnant patient

Hydatid cyst disease is very rare in pregnancy having an incidence of 1 in 20,000 pregnancies and there is no recommended standard treatment. Both surgical and medical modalities have been tried. Modalities that do not use ionizing radiation such as ultrasound and magnetic resonance imaging should be preferred for diagnosis and evaluating acute conditions in a pregnant patient. In this article, a rare pelvic cyst hydatid case surrounding the uterus and MRI findings in a young pregnant patient who was coincidentally determined is represented.

Mediastinal teratoma with coexisting parenchymal pulmonary cystic lesion

A double-located mediastinal and intrapulmonary cystic teratoma is a rare condition to be considered by thoracic surgeons. Clinical or radiologic diagnosis of a ruptured mediastinal teratoma into adjacent structures may be highly suggestive. An atypical presentation may indicate cautiousness for complete surgical excision. We report the case of a 14-year-old girl presenting with chronic chest pain. The radiologic work-up showed a large cystic mediastinal tumor and a heterogeneous intrapulmonary left upper-lobe lesion. We discuss the radiologic differential diagnosis of this atypical double-located thoracic tumor and the surgical strategy for complete excision.

An imported case of echinococcosis in a pregnant lady with unusual presentation

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

An analysis of possible mechanisms of unexpected death occurring in hydatid disease (echinococcosis)

Most cases of hydatid disease in human populations are due to Echinococcus granulosus. The hydatid life cycle involves passage between definitive hosts such as dogs and intermediate hosts such as sheep. Humans become accidental intermediate hosts following ingestion of food or water contaminated with eggs or by contact with infected dogs. Although hydatid disease may remain asymptomatic, occasional cases of sudden and unexpected death present to autopsy. Causes of rapid clinical decline involve a wide range of mechanisms including anaphylaxis (with or without cyst rupture), cardiac outflow obstruction or conduction tract disturbance, pulmonary and cerebral embolism, pericarditis, cardiac tamponade, myocardial ischemia, pulmonary hypertension, peritonitis, hollow organ perforation, intracerebral mass effect, obstructive hydrocephalus, seizures, cerebral ischemia/infarction, and pregnancy complications. The autopsy assessment of cases therefore requires careful examination of all organ systems for characteristic cystic lesions, as multiorgan involvement is common, with integration of findings so that possible mechanisms of death can be determined. Measurement of serum tryptase and specific IgE levels should be undertaken for possible anaphylaxis.