One-stage operation for hydatid disease of lung and liver: principles of treatment

OBJECTIVE: Hydatid disease is endemic in many countries throughout the world. Although we do not have exact figures, the disease is prevalent in Turkey. A considerable number of patients have additional liver cysts as well. In this study we reviewed our experience with hydatid disease of the lung and liver and discussed the principles of treatment. METHODS: From 1971 to 1999, 2509 patients with pulmonary hydatidosis were referred to us, and 485 of them had concomitant liver cysts. Of these, 405 patients had cysts located on the dome of the liver, and they were operated on with phrenotomy through a right thoracotomy. Eighty patients who were found to have concomitant liver cysts in the lower part of the liver were referred to general surgery for a laparotomy. RESULTS: Hydatid cysts located in the lungs were managed by means of cystotomy and capitonnage. For liver cysts, cystotomy and inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. In case of multiple cysts in the liver, needle aspiration was preferred. Twelve major complications, including excessive biliary drainage and bronchobiliary fistula, occurred in these patients. CONCLUSIONS: We believe that management of pulmonary and hepatic cysts simultaneously through the thoracic route is convenient and should be encouraged in patients because this prevents a second operation. Needle aspiration can be applied only for liver cysts. It is absolutely contraindicated in lung hydatid cysts.     

Primary paraspinal hydatid cyst treated with puncture, aspiration, injection and re-aspiration (PAIR) technique: a case report

Hydatid disease is a parasitic tapeworm infection that usually involves liver and lungs. Primary skeletal muscle hydatid cyst without liver and lung involvement is rare. En bloc resection without inducing rupture and spreading the daughter cyst is recommended treatment strategy and accepted to be curative for intramuscular hydatid cyst. We report a case of primary hydatid cyst of the erector spinae muscle which was treated successfully with ultrasonography guided puncture, aspiration, injection of 95% ethanol and re-aspiration (PAIR) technique.     

Hydatid disease and massive cardiac involvement.

Cardiac hydatid cysts are rare and represent 0.5-2% of all cases. Cardiac localization of hydatid cysts usually occurs in adults. Diagnosis is difficult because of the long latency between infection and manifestation of the disease, and also symptoms are nonspecific. We present a case study of 13-year-old girl with lots of hydatid cysts localized in the neighbourhood of the inferior vena cava right atrium and the superior vena cava right pulmonary artery aorta and posterior portion of the left atrium and the left ventricle, and the intramyocardium of the posterior wall of the left ventricle. An abdominal computed tomography scan showed a solitary cyst in the right posterior lobe of the liver. Following albendazole therapy for 3 weeks, she was operated on without cardiopulmonary bypass. Numerous alive and dead cysts were removed. Hepatic cysts were drained by percutaneous ultrasonography guided aspiration technique after surgery. On the 8th postoperative day, she was discharged while she was still on albendazole therapy.     

Cystic Disease of the Liver

The clinical presentation, pathology, and appropriate surgical management of cysts of the liver were analyzed in a review of 150 cases of hepatic cystic disease encountered surgically at the Mayo Clinic from Jan. 1, 1954, through Dec. 31, 1971. The incidence of this disease was 17 per 10,000 abdominal explorations. The series included 82 solitary cysts, of which 15 produced symptoms; 49 multiple cysts, of which 7 were symptomatic; 13 hydatid cysts, of which 12 were symptomatic; 3 traumatic cysts, of which 2 were symptomatic; and 3 inflammatory cysts, of which 1 was symptomatic. Symptoms, when present, comprised (in order of frequency) the presence of an abdominal mass, abdominal pain, and hepatomegaly. Congenital and hydatid cysts were located most often in the right lobe of the liver. The smallest cysts were the multiple cysts (average diameter, 4.3 cm) and the largest were the hydatid cysts (average diameter, 10.5 cm). Histologically, the lining of the congenital cysts most often was of cuboidal epithelium. The treatment of congenital cysts included simple biopsy, aspiration, and excision. In cases of hydatid cysts, preliminary sterilization was found to be essential prior to aspiration. Hydatid cysts may be excised or opened, evacuated, and the cavity obliterated. In certain cases hepatic resection may be warranted in order to remove all of the hydatid disease.     

One stage surgical management of hydatid cyst of lung &; liver—by right thoracotomy &; phrenotomy

Introduction Hydatid cysts of the lung are quite frequent in our country. Some patients have additional cysts in the liver. Though most of the liver cysts remain asymptomatic for long time, but may be symptomatic with increasing size. Surgical removal is the treatment of choice for both lung & liver cysts. Aim of the study was to establish suitability of one stage surgery for pulmonary & hepatic hydatid cysts. Methods From 1996 through 2003 we operated on 216 pulmonary hydatid cysts, out of which 42 patients had hydatid cysts in the right lung as well as in the right lobe of liver. Right thoracotomy was done to remove the lung hydatids followed by phrenotomy to remove the liver cysts. Results Right thoracotomy was done in 42 patients having hydatid cysts of lung & liver. In 36 patients, cysts were removed, bronchial leaks were sutured & residual cavities were obliterated. Out of rest 6 patients, having dense adhesions or destruction of pulmonary parenchyma, 4 had segmentectomy & 2 had lobectomy. Right phrenotomy was then done with radial incision above the palpated liver cysts. Hydatid cyst was removed from liver. Cavity and remaining pericystic liver tissue was inverted with sutures. Water seal chest drain & subdiaphragmatic drain were placed. Post operative albendazole was continued for 3 months in the dose of 10–20 mg/kg with a gap of 2 weeks after each month. Post operative recovery was uneventful in most of the cases. However, air leak continued for almost 3 weeks in 4 patients & 3 months in one patient. There was no death. Conclusion Surgical management of pulmonary and hepatic hydatids with one stage right thoracotomy & phrenotomy is a suitable option. It avoids additional laparotomy and thereby additional cost & hospital stay. Results are quite satisfactory.     

A two-stage approach to a patient with hydatid cysts inside the right pulmonary artery and multiple right lung involvement.

We report on the surgical treatment of a patient in whom hydatid cysts inside the right pulmonary artery and multiple right lung involvement were detected. Since the right pneumonectomy carried a high risk of cyst rupture, and migration of the cysts to the opposite lung during ligation of the pulmonary artery, a two-stage surgical approach was scheduled. Hydatid cysts located at the proximal pulmonary artery were removed by performing a longitudinal arteriotomy along the pulmonary artery to the bifurcation. Subsequently, a right pneumonectomy was performed on a safe right pulmonary artery in a different session.     

Laparoscopic management of hepatic hydatid disease.

BACKGROUND: Hydatid disease is an endemic condition in several parts of the world. Owing to ease of travel, even surgeons in nonendemic areas encounter the disease and should be aware of its optimum treatment. A safe, new method of laparoscopic management of hepatic hydatid disease is described along with a review of the relevant literature. METHODS: Sixty-six cases of hepatic hydatid disease were operated on laparoscopically using the Palanivelu Hydatid System. The special trocar-cannula system used and the technique of operation are described. RESULTS: The majority of the patients presented with pain. Most of the patients had only a single cyst. The right lobe of the liver was most commonly involved. Cysts were bilateral in 4 patients. In 83.3%, simply evacuation of the hydatid cyst by the Palanivelu Hydatid System was done. In 13.7%, this was followed by a left lobectomy, as the cysts were large occupying almost the entire left lobe of the liver. The remnant cavity was dealt with by omentoplasty. The average follow-up period is 5.8 years. There have been no recurrences to date. CONCLUSION: We recommend Palanivelu Hydatid System for management of hepatic hydatid disease. We have found its efficacy to be optimum for preventing spillage, evacuating hydatid cyst contents, performing transcystic fenestration, and for dealing with cyst-biliary communications.     

Percutaneous treatment of the liver hydatid cysts under sonographic guidance

This paper is a retrospective study of the first 51 cases of liver hydatid cysts, which underwent a conservative treatment between April 1996-December 2000. There were 28 females and 23 males with a mean age of 40.1 years (7-65), which had 63 liver hydatid cysts. In the right liver lobe were located 46 cysts, in the left liver lobe were located 7 cysts and in 10 cases cysts were located in both liver lobes. In 4 cases a pulmonary hydatidosis was associated. Abdominal ultrasound and CT scan were routinely performed and the cysts were classified in type I and II after Gharbi's classification. All of these 63 cysts were treated by ultrasound guided fine-needle percutaneous puncture with aspiration and instillation of sterile alcohol 95 degrees. Pre and postoperative the patients were treated with mebendazol or albendazol. They were followed-up by ultrasound and CT scan examination in the second day postoperative and monthly. No new cysts were noted during an average follow-up of 14.7 months and maximal cyst diameter decreased with minimum 72%. Two episodes of reversible anaphylaxis were encountered. The mean hospital stay was 3.3 days. In this paper the indications for conservative treatment and preliminary results of this method are discussed.     

Multi-sited hydatid cystic disease with muscular involvement in a young female: A case report from Syria

IntroductionHydatidosis is a unique disease caused by a tapeworm called Echinococcus granulosus. Musculoskeletal involvement with hydatid cystic disease accounts for less than 5% of all cases. The main purpose of this study is to present a case of multi-sited hydatid cystic disease and how to manage it.Presentation of caseHere we present a case of 14-year-old girl complained of a gradually enlarging mass on her left shoulder with a final diagnosis of triple-sited hydatid cystic disease including the right lung, the left trapezius muscle and the liver.DiscussionThe diagnosis was made by non invasive radiological procedures (CT scan and MRI). The management consisted of aspiration and reinjection of hypertonic solution to the lung cyst followed by complete surgical resection, enucleation of the muscular lesion and conservative management of the liver lesion. After Three months of follow up there was no recurrence at the sites of operation and the liver cyst reduced in size.ConclusionMulti-sited hydatid cysts could be treated through one stage surgery followed by chemotherapy with benzimidazoles.     

One-stage Transthoracic Operation for the Treatment of Right Lung and Liver Hydatid Cysts

In this study we reviewed our experience of hydatid disease of the lung and the liver and discussed the safety and the follow-up results of the one-stage operation. Between 1990 and 2004, 142 patients with pulmonary hydatid disease underwent operation in our clinic. Of these, 27 (19%) patients had cysts located on the dome of the liver, treated with phrenotomy through a right thoracotomy. Hydatid cysts located in the lungs were managed by means of cystotomy. For liver cysts, cystotomy and the inversion of the cavity with sutures was the surgical method of choice, and a drain was left in place. The pulmonary cysts of 12 (8.4%) patients were bilateral and 5 (3.5%) patients had prior surgical treatment of hepatic (n = 1) or pulmonary (n = 4) hydatid cysts. The liver cysts were approached transdiaphragmatically after the lung cysts were excised in 27 (19%) patients. In patients with pulmonary cysts, cystotomy, with or without capitonnage was performed on 123 (86.6%) patients, and wedge resection was performed on 11 (7.7%), segmentectomy was performed on 6 patients (4.2%), and lobectomy was performed on 2 (1.4%) patients. There was no mortality, and only a small number of complications were encountered: empyema in 3, excessive biliary drainage in 2, and bronchopleural fistula in only 1. We suggest that the extraction of pulmonary and hepatic cysts simultaneously through the transthoracic route is a useful and safe surgical technique. This technique also prevents the need for a second operation.     

Hydatid cyst of the heart: An uncommon lesion

Hydatid cyst is caused by the tapeworm Echinococcus granulosus. It usually involves liver and lungs in humans. Cardiac hydatid cyst is rare, commonly affecting the left ventricle. Here we are reporting a case of Hydatid cyst in the right ventricle without any involvement of liver and lungs which was successfully managed.     

One-stage surgical management for lung and liver hydatid diseases

BACKGROUND: Hydatid disease remains a serious health problem in Mediterranean areas. We reviewed the efficacy of a single-stage operation in coexisting cysts of lung and liver in patients. METHODS: Forty-one patients operated for the cysts located on the dome of the liver and right lung with one-stage surgical approach on between 1990 and 2010. There were 19 males (46%) and 22 females (54%) patients. The age range was 10–82 years, with a median age of 34 years. RESULTS: All patients had simultaneous operations for both organs via right thoracotomy and phrenotomy except one patient. Surgical techniques used in the lung were cystotomy and capitonnage, with wedge resection of the destroyed lung parenchyma in three (7.3%) and additional decortication in three (7.3%). Cystotomy was applied with membrane removal in the liver cysts. Postoperative complications were prolonged biliary drainage, empyema, prolonged air leak, pleural effusion in one case (2.4%) each, respectively. All patients managed successfully and discharged. No hospital mortality occurred. CONCLUSIONS: We propose that concomitant right pulmonary and liver dome hydatid cysts can be treated effectively and safely in a one-stage operation through a right posterolateral thoracotomy and phrenotomy.     

Unusual Location of Hydatid Cysts: A Case Report and Literature Review

Hydatid cysts develop most frequently in the liver and lungs, but they are occasionally found in other organs. Hydatid cysts in the axillary space are an extremely rare event in areas where the disease is endemic, and are still common in many countries, including Turkey. A 73-year-old man presented to our clinic with a painful axillary mass. Thoracoabdominal computed tomography revealed multilocular cystic masses localized in the left axillary space, with minimal invasion of the peripheral soft tissue and no pulmonary or hepatic involvement. An echinococcal indirect hemagglutination test was negative. The masses were dissected through their stalks and removed completely. Macroscopic and microscopic examination of the specimens confirmed hydatid cysts. This case report demonstrates that hydatid cysts should be considered as a possible cause for palpable lesions in the axillary region or chest wall, especially in endemic locations.     

Changes in surgical therapy of pulmonary hydatid cysts

The lung is the second most common site of hydatid cysts after the liver. The authors analyse retrospectively the results of patients treated with pulmonary hydatid cysts in the past 18 years, considering video-thoracoscopy. Twenty eight patients were treated during this period in 31 cases. Hydatid disease affected only the lung in case of 22 patients, while in 6 cases it was present in the liver and lung simultaneously. Pulmonary hydatid disease affected one side in 24 and both sides in 4 cases. For surgical treatment pericystectomy in one, atypical segment resection in 18, anatomical segmentectomy in three, lobectomy in 7 and video-thoracoscopy in 3 cases were performed without surgical complications. The mean hospital stay was 10.5 days in case of thoracotomies and 8.5 days in case of video-thoracoscopy. There was one recurrence in conventional surgery and reoperation was necessary. After video-thoracoscopy no recurrence was detected. Mean follow-up was 120 months, after video-thoracoscopy it was 20 months. Three patients have uncertain chest pain after thoracotomy, but none has any complaints after video-thoracoscopy. Fifteen patients took mebendazole permanently after the final histological result. According to the authors' practice the indication of lung resections for pulmonary hydatid cysts is limited, in selective cases video-thoracoscopic cystectomy can be a successful treatment of choice.     

Clinical and radiographic features of simple and hydatid cysts of the liver

The advances of hydatid chemotherapy and the non-operative management of simple (epithelial) hepatic cysts make a correct diagnosis of increasing importance. Twenty-six patients with hepatic hydatid cysts and eleven with simple cysts were reviewed. In both groups clinical presentation was most frequently due to pain. Sex, age and size of the cysts were similar. Hydatid serology was negative in six of the hydatid patients (23 per cent). None of the simple cyst patients had positive serology but one had a borderline titre. Ultrasound and computerized tomography identified daughter cysts within the main cyst in only 17 hydatid cysts (65 per cent) and considerable intra-cyst debris was also present in five of the simple cysts. Seven of the simple cysts were deroofed surgically and the remainder underwent percutaneous aspiration. Sixteen of the hydatid cysts were found to have a biliary communication whereas this was not found with any simple cyst. The difficulties in making a precise diagnosis in some patients with a liver cyst should deter the interventional radiologist and restrain the hydatid chemotherapist.     

Primary hydatid cysts of psoas muscle

Background: Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in muscle is not common, accounting for 2?3% of all sites; even rarer is the development of multiple cysts. Methods: The patient presented with a painless abdominal mass which gradually increased in size to a diameter of approximately 16 cm. Organ imaging scan revealed multiple hydatid cysts within the right psoas muscle. Because of the proximity of the lesions to the iliac vessels, ureter and nerves to the lower limb, percutaneous drainage and alcoholization under local anaesthesia were ­performed with the aim of reducing the size of the cysts and sterilizing them prior to definitive surgery. This procedure was not effective. Two weeks after percutaneous treatment the patient underwent surgery. Results: At operation the cysts were localized and successfully removed under ultrasound guidance. Postoperative stay was ­uneventful. Two years after surgery the patient has no evidence of recurrent hydatid disease. Conclusions: Ultrasonography is the preferred method for detecting muscular hydatid cyst and for guiding the surgeon during resection.     

Management of pulmonary hydatid cysts in a tertiary care centre in Northeast India

Background

Hydatid cysts are the most common parasitic disease of the lungs. We reviewed our experience with pulmonary hydatid cysts focusing on clinical symptoms, diagnostic methodology, operative management and their outcome in our centre.

Methods

Between October 2008 and September 2013, 37 patients were operated in our department for lung parenchymal hydatid cysts. Twenty-six patients were female and 11 were male. The mean age of the patients was 30.6 years with a range of 16–44 years. The cysts were located in the right lung in 22 (59.46 %) patients, left lung in 14 (37.84 %) and bilaterally in 1 (2.70 %). We performed enucleation and capitonnage in 29 cases, cystotomy-drainage and capitonnage in 6 cases, wedge resection in 1 case and lobectomy in 1 case. Albendazole was given postoperatively to selected patients considered to be at high risk for recurrence.

Results

Chest X-ray, computerized tomographic scanning of the thorax was done in all cases for diagnosis. Most of the patients presented with solitary pulmonary cysts. One patient had bilateral pulmonary cysts and four patients had concomitant liver cysts. Postoperatively, there was no major morbidity. There was no in-hospital or 30-day mortality. The follow-up data was complete for 29 of the 37 patients. The mean follow-up period was 2.6 years with a range of 6 months to 5 years. During the said period, none of the patients had shown any recurrence.

Conclusion

Surgery for hydatid cysts of the lung can be safely performed, with low morbidity and a negligible mortality rate and is the treatment of choice.     

Hydatid Cystic Disease of the Soft Tissues with Pulmonary and Hepatic Involvement: Report of a Case

Hydatid disease, which is caused by the Echinococcus granulosis parasite, is endemic in certain parts of the world where close contact between humans and sheep exists. The disease most commonly involves the liver and other solid organs. This report describes the case of a teenage girl with hydatid disease involving the right axilla and various other sites concomitantly. The patient was admitted to hospital with a mass in the right axillary region, and further examinations revealed that the liver and right lung were also involved. We report this case to emphasize that hydatid disease should be considered in the differential diagnosis of patients from endemic areas who present with soft tissue masses. Received: September 25, 2001 / Accepted: May 7, 2002 Reprint requests to: Ş. Dilege     

Concurrent intrapericardial–pulmonary hydatidosis: an unusual multisystem echinococcosis

A 46-year-old male presented with breathlessness for a few months. He had been operated twice for liver hydatid cysts and once for right pulmonary hydatid cysts at other hospitals. Now he was found to have one hydatid cyst in the upper lobe of the left lung and multiple hydatid cysts adjoining left heart border. On computed tomography (CT) scan chest and echocardiography, it was difficult to ascertain whether these cysts were pulmonary or intrapericardial. Left ventricular ejection fraction (LVEF) was 25%. Enzyme-linked immunosorbent assay (ELISA) was positive for hydatid. Left posterolateral thoracotomy revealed dead hydatid cyst in upper lobe of the lung that was removed. Infected mother hydatid cyst was encountered inside pericardial sac. Scores of daughter hydatid cysts, varying in size from 1 to 30 mm, were scooped out intact from the pericardial cavity. There was significant improvement in cardiac activity, once the tamponade effect of hydatid cyst was removed. Pericardium was about 1 cm thick with lot of purulent and necrotic slough. To prevent future constrictive pericarditis, subtotal pericardiectomy was done. Intrapericardial hydatid cyst should be kept in mind whenever it obscures the heart border and patient has features of cardiac tamponade. Early surgical intervention may be required in these cases.     

Surgical treatment of pulmonary hydatid cysts: report of 139 cases

Hydatid disease is a parasitic infestation that is endemic in many sheep- and cattle-raising areas and is still an important health problem in the world. The aim of our study was to present our surgical experience and strategy in the management of pulmonary hydatid disease. One hundred thirty-nine patients with pulmonary hydatid cysts underwent surgical treatment in our clinic between January 1990 and April 2002. A total of 169 cysts were present in 139 patients. Fifteen patients had concomitant hydatid cysts in liver and lung. Our series consisted of 76 male and 63 female patients, and mean age was 28.6 +/- 17 years (range, 5-65 years). Only pulmonary hydatid cysts were seen in 123 patients (88.5%), whereas there were 15 patients (10.8%) with combined pulmonary and hepatic disease. Hydatid cyst was found in a patient both in lung and spleen (0.7%). Lateral thoracotomy was performed in 115 patients (82.73%), bilateral thoracotomy in 9 patients (6.48%), thoracophrenotomy in 11 patients (7.91%), and median sternotomy and phrenotomy in 4 patients (2.88%). Resection techniques were used only in 10 patients. The most common complication was atelectasis (5.0%). The mortality rate was 1.8% (3 patients). Surgery is the treatment of choice for most patients with pulmonary hydatid cysts. Thoracaphrenotomy can be chosen as the surgical procedure in management of hepatic and pulmonary hydatid cysts.