Pulmonary hydatidosis with hepatopleural fistula: A case report

INTRODUCTION AND IMPORTANCE

Cystic echinococcosis (CE) is a chronic illness caused by the tapeworm Echinococcus granulosus. It is classified as a neglected disease and is a priority according to the World Health Organization. CE is prevalent in populations engaged in specific livestock practices and is associated with poor living conditions.

CASE PRESENTATION

41-year-old female Maasai patient who presented with symptoms of cough, dyspnea, fever, and weight loss. Physical examination and CT scans confirmed the presence of cystic masses in the lungs and liver. The patient underwent a thoracotomy procedure to address complications from a hepato-pleural fistula.

CLINICAL DISCUSSION

Echinococcus is a tropical disease that affects over a million people worldwide annually. It primarily affects communities engaged in animal husbandry and causes the development of hydatid cysts. Diagnosis can be challenging due to prolonged asymptomatic periods. In rare cases, cysts can rupture into the pleura and bronchial tree, causing respiratory symptoms. Surgical treatment involves the systematic evacuation of cysts and visceral cyst excision, with concurrent laparotomy and thoracotomy being the optimum approach.

CONCLUSION

Hydatid cysts remain a significant health problem, particularly when large pleural cysts occur with subphrenic liver cysts. Surgical intervention, specifically a single-stage thoracotomy, is the preferred first-line treatment. This approach allows for both cysts to be addressed in a single procedure, providing effective and efficient treatment to patients.

Management of Pulmonary Hydatidosis and Lung Abscess in Low-Resource Settings

In the modern era, infections of the lung are typically managed medically. However, all pulmonary hydatid cysts require surgery with rare exceptions, and bacterial abscesses require surgery if they are complicated, resistant to treatment, and/or large. Surgical treatment of these pulmonary conditions requires clinical knowledge of tests for causative organisms, perioperative antimicrobial therapies, options for surgical management, and postoperative care.

Is There Any Role of Pulmonary Endarterectomy in Pulmonary Arterial Hydatidosis?

BACKGROUND

Hydatid Cyst is a zoonosis caused by Echinococcus granulosis. Pulmonary artery involvement is a rare condition. The aim of this study was to review our experience in the surgical treatment of pulmonary arterial hydatidosis.

METHODS

Data were collected prospectively for consecutive patients who underwent pulmonary endarterectomy and had a diagnosis of hydatidosis at or after surgery.

RESULTS

Eight patients (two male, six female, mean age, 31.25±13.68 years) with hydatidosis were defined. Only one patient presented with hemoptysis, while the rest of the patients reported exertional dyspnea as their main symptom. Cardiac hydatidosis associated with pulmonary arterial involvement was noted in one patient. The mean time interval for duration of disease was 12±24.29 months before PEA. Mortality was observed in two patients due to massive hemoptysis in one and right heart failure in one. No anaphylactic reaction was observed. Significant difference was detected in mean pulmonary vascular resistance as decline from 442.38±474.20 to 357.25±285.34 dyn/s/cm^-5 following surgery (p: 0.011). Two patients had recurrence of the disease following a median follow-up of 9.1 months All survivors improved to New York Heart Association functional class I and II.

CONCLUSIONS

Pulmonary arterial hydatidosis may mimic chronic thromboembolic pulmonary hypertension and these patients can be diagnosed with pulmonary endarterectomy. Surgery may be a therapeutic option for patients who do not respond to medical therapy if the cystic lesions are surgically accessible. Pulmonary endarterectomy should be performed only in expert centers because of the high risk of perioperative morbidity, mortality, and postoperative recurrence.

Giant pulmonary hydatid cyst in children

BACKGROUND

Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cyst (GHC) of the lung is a special clinical entity in children and is related to higher lung tissue elasticity.

AIM

To compare clinical and imaging features, types of surgical interventions, and postoperative complications in pulmonary GHC and non-giant pulmonary hydatid cysts (NGHC) in children.

METHODS

A retrospective study was undertaken. The data analyzed were taken from medical records of children with pulmonary hydatid cyst (PHC) hospitalized in a pulmonary department in Tunisia between January 2004 and February 2019. Cysts were divided according to their size into GHC ( ≥10cm) and NGHC (<10cm).

RESULTS

In the study period, 108 PHC were recorded in 84 children. GHC accounted for 21 (19.4%) and NGHC for 87 (80.6%). The median of age of the children was 11 years (IQR 1-9, IQR 3-14) and the mean age was 11.6 years (10.5 in GHC vs. 11.4 years in NGHC). Hemoptysis was found in 25% of the GHC group vs. 48.4% of the NGHC group (P=0.27). Cysts were multiple in 23.8% of cases and predominated in the right in 64.3% of cases and in the inferior lobes in 71.4% of the cases. GHCs were less frequently complicated (60% vs. 78.1% in NGHC, P≤0.11), although not significantly. Parenchymal resection was realized in 50% of GHC vs. 18.8% of NGHC (P=0.006). No significant difference was found in postoperative complications between the two groups and there was no recurrence in either group.

CONCLUSION

GHC is a special clinical entity in children. It requires major surgery with parenchymal resection, and therefore early diagnostic and therapeutic management is warranted.

Bilateral pulmonary hydatidosis associated with uncommon muscular localization

INTRODUCTION

The lung is the second most commonly affected organ by hydatidosis, and the bilateral involvement is rare even in endemic regions.

CASE PRESENTATION

We report the case of a 27-year-old patient who presented with right basithoracic pain and cough evolving for three months. Thoracic CT scan revealed two homogeneous, rounded cystic formations enhancing after injection of the contrast media, located in the lateral basal segments of the lower lobe. An abdominal CT scan was performed to rule out a hepatic localization of the hydatid cyst, revealed a cystic formation of the left psoas muscle. The diagnosis of bilateral hydatid lung cyst associated with hydatid psoas muscle location was then made. The patient underwent a two-stage thoracic surgery. The second step involved partial cystectomy of the psoas muscle hydatid cyst via a left iliac incision and using an extraperitoneal approach. The postoperative course was uneventful.

DISCUSSION

Management of bilateral pulmonary hydatid cyst is controversial. Some authors recommend operating bilateral cysts in two-stage surgery, with an interval of three to four weeks between procedures. The involvement of the psoas muscle is rare and is generally secondary to the rupture of splenic, hepatic or renal hydatid cysts. Generally, its diagnosis is delayed as the latter is most of the time asymptomatic.

CONCLUSION

Bilateral pulmonary hydatidosis associated with hydatid cyst of the psoas muscle is a rare entity. Radiological investigations and especially CT scan are the mainstay of diagnosis. Surgery remains to be the treatment modality of choice.

[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.

Recurrent hydatid cyst of liver with asymptomatic concomitant hydatid cyst of lung: an unusual presentation-case report

A 40-year-old male patient presented to us with complaints of pain in abdomen for the past 2 weeks and fever for 3 days. The patient gave history of being previously operated for hydatid cyst of liver 15 years back. His chest radiograph and computed tomography scan revealed a cystic lesion in the right lobe of liver and a cyst in left lung. The patient was managed surgically. Aspirate from the cyst fluid showed plenty of hooklets and scolices of Echinococcus granulosus. An intact brood capsule was also seen. Diagnosis of hydatidosis was further confirmed by histopathological examination. Post-operative the patient had a good recovery.

Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation: An ex-vivo pilot experimental study in animal models

AIM: To evaluate radiofrequency thermal ablation (RTA) for treatment of cystic echinococcosis in animal models (explanted organs).

METHODS: Infected livers and lungs from slaughtered animals, 10 bovine and two ovine, were collected. Cysts were photographed, and their volume, cyst content, germinal layer adhesion status, wall calcification and presence of daughter or adjacent cysts were evaluated by ultrasound. Some cysts were treated with RTA at 150 W, 80°C, 7 min. Temperature was monitored inside and outside the cyst. A second needle was placed inside the cyst for pressure stabilization. After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal layer was necrotic.

RESULTS: The subjects of the study were 17 cysts (nine hepatic and eight pulmonary), who were treated with RTA. Pathology showed 100% success rate in both hepatic (9/9) and lung cysts (8/8); immediate volume reduction of at least 65%; layer of host tissue necrosis outside the cyst, with average extension of 0.64 cm for liver and 1.57 cm for lung; and endocyst attached to the pericystium both in hepatic and lung cysts with small and focal de novo endocyst detachment in just 3/9 hepatic cysts.

CONCLUSION: RTA appears to be very effective in killing hydatid cysts of explanted liver and lung. Bile duct and bronchial wall necrosis, persistence of endocyst attached to pericystium, should help avoid or greatly decrease in vivo post-treatment fistula occurrence and consequent overlapping complications that are common after surgery or percutaneous aspiration, injection and reaspiration. In vivo studies are required to confirm and validate this new therapeutic approach.