Excision of a giant hydatid cyst of the lung under thoracic epidural anaesthesia

[Our clinical experience and follow-up results in hydatid cyst cases: a review of 393 patients from a single center]

BACKGROUND AND OBJECTIVES

Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus. The aim of our study is to present the clinical features of the patients who were treated for hydatid cyst, determine the interventional techniques and anesthesia methods used and review the occurred complications in detail.

METHODS

This study included 393 patients who were followed up and/or treated with the diagnosis of hydatid cyst between January 2013 and November 2018. The patients' data was evaluated retrospectively.

RESULTS

The mean age of the patients was 31.0±17.2 years. Of the patients, 111 (28.4%) had more than one cyst and 36 (9.2%) patients had multi-organ involvement. Six of the patients refused the intervention or was transferred to another hospital. Among the remaining 387 patients, 335 (85.2%) received general anesthesia and intubation, 9 patients (2.3%) received general anesthesia and laryngeal mask airway, 39 patients (9.9%) received sedoanalgesia and 4 patients (1%) received regional anesthesia. Perioperative mortality was developed in one patient. The most common periopertaive complication was allergic reaction (1.5%), whereas the most common post-operative complications were atelectasis (3.3%) and biliary fistula (3%). The mean Intensive Care Unit stay (ICU) was 1.9±1.1 days in patients requiring ICU. Recurrence during the 40±17 months follow-up occurred in 8.4% patients.

CONCLUSIONS

Anesthesiologists have an important role in the management of hydatid cyst patients. Patients should be evaluated exhaustively in terms of multi-organ involvement and the presence of more than one cyst in the same organ. The type of treatment procedure and the localization of the cysts determine the anesthetic management.

[Our clinical experience and follow-up results in hydatid cyst cases: a review of 393 patients from a single center]

BACKGROUND AND OBJECTIVES

Hydatid cyst is a zoonotic disease caused by Echinococcus granulosus. The aim of our study is to present the clinical features of the patients who were treated for hydatid cyst, determine the interventional techniques and anesthesia methods used and review the occurred complications in detail.

METHODS

This study included 393 patients who were followed up and/or treated with the diagnosis of hydatid cyst between January 2013 and November 2018. The patients’ data was evaluated retrospectively.

RESULTS

The mean age of the patients was 31.0 ± 17.2 years. Of the patients, 111 (28.4%) had more than one cyst and 36 (9.2%) patients had multi-organ involvement. Six of the patients refused the intervention or was transferred to another hospital. Among the remaining 387 patients, 335 (85.2%) received general anesthesia and intubation, 9 patients (2.3%) received general anesthesia and laryngeal mask airway, 39 patients (9.9%) received sedoanalgesia and 4 patients (1%) received regional anesthesia. Perioperative mortality was developed in one patient. The most common periopertaive complication was allergic reaction (1.5%), whereas the most common post-operative complications were atelectasis (3.3%) and biliary fistula (3%). The mean Intensive Care Unit stay (ICU) was 1.9 ± 1.1 days in patients requiring ICU. Recurrence during the 40 ± 17 months follow-up occurred in 8.4% patients.

CONCLUSIONS

Anesthesiologists have an important role in the management of hydatid cyst patients. Patients should be evaluated exhaustively in terms of multi-organ involvement and the presence of more than one cyst in the same organ. The type of treatment procedure and the localization of the cysts determine the anesthetic management.

Cystic echinococcosis in sub-Saharan Africa

Cystic echinococcosis is regarded as endemic in sub-Saharan Africa; however, for most countries only scarce data, if any, exist. For most of the continent, information about burden of disease is not available; neither are data for the animal hosts involved in the lifecycle of the parasite, thus making introduction of preventive measures difficult. Available evidence suggests that several species or strains within the Echinococcus granulosus complex are prevalent in sub-Saharan Africa and that these strains might be associated with varying virulence and host preference. Treatment strategies (chemotherapy, percutaneous radiological techniques, but mainly surgery) predominantly target active disease. Prevention strategies encompass anthelmintic treatment of dogs, slaughter hygiene, surveillance, and health-educational measures. Existing data are suggestive of unusual clinical presentations of cystic echinococcosis in some parts of the continent, for which the causes are speculative.

Respiratory Diseases

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Pulmonary arteriovenous fistulas have congenital and hereditary etiology, and patients are at risk for life-threatening rupture requiring surgery.

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Wegener's granulomatosis can affect any organ system, although renal and pulmonary involvement is most common; men ages 40 to 50 are at increased risk.

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Lymphomatoid granulomatosis affects cardiopulmonary, neurologic, and myeloproliferative systems; may result from opportunistic infection, and frequently progresses to lymphoma; men age 50 to 60 are at increased risk. Spontaneous remission occurs in some cases; mortality is 60% to 90% at 5 years.

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Churg-Strauss syndrome is usually associated with long-standing asthma, with men and women affected equally, and can affect any organ system; major cause of death is cardiac related.

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Primary pulmonary hypertension is a diagnosis of exclusion; women are affected twice as likely as men; right-to-left shunt may occur in 30%, secondary to patent foramen ovale; hypoxia with resultant heart failure is typical cause of death.

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Cystic fibrosis is an autosomal recessive disease, eventually fatal, with increased risk for airway obstruction, fluctuating pulmonary function, and chronic hypoxia; risk for spontaneous pneumothorax is 20%.

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Bronchiolitis obliterans organizing pneumonia is a pulmonary obstructive disease that may be reversible and usually resolves spontaneously.

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Idiopathic pulmonary hemosiderosis is associated with autoimmune disorders; patients have recurrent hemorrhage, pulmonary fibrosis, restrictive lung disease, and pulmonary hypertension, with some cases of spontaneous remission.

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Chronic eosinophilic pneumonia may be preceded by adult-onset asthma; women are at increased risk; prognosis is good.

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Goodpasture's syndrome is a genetic autoimmune disorder involving the pulmonary and renal systems.

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Pulmonary alveolar proteinosis, a lipoprotein-rich accumulation in alveoli, has three forms: congenital, decreased alveolar macrophage activity, and idiopathic; some cases of spontaneous remission occur.

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Sarcoidosis may affect any organ system; African American, northern European, and females are at greater risk; many patients are asymptomatic.

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Systemic lupus erythematosus may affect any organ system; women of childbearing age are at increased risk.

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Idiopathic pulmonary fibrosis is a rare interstitial lung disease, with smokers at increased risk for pulmonary malignancy; survival is usually 2 to 3 years from diagnosis; no effective treatment exists, with lung transplant the only therapeutic option.

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Acute respiratory distress syndrome (ARDS) is associated with underlying critical illness or injury, developing acutely in 1 to 2 days; mortality is 25% to 35%.

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Pulmonary histiocytosis X is an interstitial lung disease associated with cigarette smoking and an unpredictable course; some spontaneous remission occurs.

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Lymphangioleiomyomatosis involves progressive deterioration of lung function, associated with tuberous sclerosis and exacerbated by pregnancy, with women at increased risk; possible spontaneous pneumothorax and chylothorax; death usually results from respiratory failure.

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Ankylosing spondylitis is a genetic inflammatory process resulting in fusion of axial skeleton and spinal deformities, with men at increased risk; radiologic bamboo spine, sacral to cervical progression, and restrictive lung disease with high reliance on diaphragm; extraskeletal manifestations may occur.

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Kyphosis (exaggerated anterior flexion) and scoliosis (lateral rotational deformity) are spinal/rib cage deformities with idiopathic, congenital, or neuromuscular etiology; corrective surgery done if Cobb thoracic angle >50% lumbar angle >40%.

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Bleomycin is an antineoplastic antibiotic used in combination chemotherapy, with no myelosuppressive effect; toxicity can cause life-threatening pulmonary fibrosis.

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Influenza A is highly infectious, presenting with flulike symptoms and possible progression to ARDS; human-to-human exposure is through droplets or contaminated surfaces, with high risk for infants, children, pregnancy, chronically ill, or renal replacement therapy patients. No prophylactic treatment exists; treat patients with high index of suspicion without definitive testing; rRT-PCR and viral cultures are sensitive for pandemic H1N1 strain.

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Severe acute respiratory syndrome (SARS) is highly infectious, transmitted by coronavirus with human-to-human exposure via droplets or surfaces, and may progress to ARDS.

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Echinococcal disease of lung is from canine tapeworm, transmitted by eggs from feces; rupture of cyst may result in anaphylactic reaction or spread of disease to other organs; children are at increased risk. No transthoracic needle aspiration is done; surgery is only option.

Pulmonary hydatid and other lung parasitic infections

The lung may be infested by a great number of parasites. Hydatidosis is the most frequent parasitic lung disease. Diagnosis of lung hydatidosis is usually easy on chest radiography, ultrasonography, and CT scan, and immunodiagnosis may help in dubious cases. Surgery is necessary in most cases, but it must be conservative. Complex forms, such as disseminated disease and secondary lung hydatidosis (metastatic or bronchogenic) are difficult to treat and may be considered malignant. Medical treatment may be helpful in complex forms, in poor surgical risk patients, and in cases of preoperative spillage of hydatic fluid. Prevention programs are necessary in endemic areas, and research must be directed toward vaccination against the parasite. Other parasitic diseases are reported less frequently in the literature, and the majority of published articles are either case reports or only report a small number of cases. Clinical presentation is variable according to the great variety of parasites that may involve the lungs.