Difficult diagnosis in pulmonary hydatidosis

Echinococcosis is a disease caused by a small taenid-tape of Echinococcus granulosus, a parasite that lives in the intestine of canines. Occasionally the intermediate host is the human being and it is located especially in the liver and in the lung having the shape of cysts. The diagnosis is often difficult because of the radiological aspect of the cysts, which are very much alike some tumor. The abstract contains two cases of pulmonary hydatid cyst and its steps towards the final diagnosis.     

Secondary bronchogenic pulmonary hydatidosis]

Secondary bronchogenic hydatid disease is a rare and little known complication of primary hydatid cyst of the lung, which is even refuted by some authors. We report 7 cases of secondary bronchogenic hydatid after surgical cure of a hydatid cyst which had ruptured into the bronchi, while the last case concerned a young girl who was treated by corticosteroids for rheumatoid arthritis and who developed secondary bronchogenic hydatid from a cyst rupturing into the bronchi in the absence of surgery. Hydatid dissemination was ipsilateral to the primary cyst in 5 cases, controlateral in one case and bilateral in one case. Five patients underwent radical surgery. The patient with bilateral dissemination was operated on one side and a large number of residual cysts were eliminated by vomica, as for the last patient; these two patients are still under surveillance. The operation and general anaesthesia played a predisposing role in the pathogenesis of this complication and inhibition of immune mechanisms could also play a role. Prevention is necessary when treating a hydatid cyst of the lung which has ruptured into the bronchi. Treatment is surgical, bearing in mind that a large number of secondary cysts can be eliminated by vomica or may involute spontaneously.     

15 Years in surgical management of pulmonary hydatidosis.

OBJECTIVES: Echinococcosis remains an endemic surgical problem in countries where sheep and cattle raising is carried out, particularly in many Mediterranean countries. This study aims to evaluate the management of different presentations of pulmonary hydatidosis and their outcome over 15 years. DESIGN: Retrospective study.Setting: Thoracic surgical department, Chest Diseases Hospital, Kuwait. PATIENTS: Sixty patients operated upon for hydatid disease were evaluated pre- and post- operatively; 35 males, 25 females with a mean age of 28.4 years. Most patients were investigated by laboratory, serological and radiological studies. Different surgical techniques were used to remove the hydatid cyst from the lung. RESULTS: The most common presenting symptoms were cough (41 patients), and 12 patients were asymptomatic. Chest X-ray showed a rounded shadow in 42 patients; 19 cases were of vigorous size >10 cm. Thoracotomy was done in 57 patients; two chest wall cases were managed by minimal skin incision and enucleation, one hydatid cyst of the heart was approached through a median sternotomy. The mean hospital stay was 9 days. Postoperative complications occurred in 9 patients; prolonged air leak in 4 patients, pleural effusion in 3, pneumothorax, and wound infection in one patient each. One patient (65 years old) died on the 6th post-operative day most probably from pulmonary embolism. In a follow-up period of 2-15 years, 4 recurrences have been noted. CONCLUSION: Surgical excision of pulmonary hydatidosis with maximum preservation of the lung parenchyma is the main stay of treatment.     

Surgical management of complicated pulmonary hydatidosis]

1954-1988, 680 patients with pulmonary hydatid cysts were operated upon at our hospital. 320 of the patients were classified as having complicated pulmonary hydatidosis (CPH). The criteria for CPH are as follows: (1) huge in size, occupied 2/3 or one side of the chest; (2) ruptured hydatid cyst or cysts, with or without secondary infection; (3) multiple lesions involving both lungs, sometimes combined with liver involvement; (4) the presence of hepato-pleural and/or hepato-bronchial fistulae. We advocated intact endocystectomy and saucerization of the residual actocystic pit for individual lesion. The diagnosis and management of different CPH, especially those with hepato-pleural or hepato-bronchial fistulae were discussed in detail. There were 2 operative deaths. The mortality rate of the whole series was 0.29%, and of those with CPH was 0.6%.     

Use of mebendazole in the treatment of pulmonary hydatidosis

After recalling the various therapeutic aids proposed for the treatment of hydatid disease, personal experience in the use of mebendazole in patients suffering from pulmonary hydatidosis is reported. On the basis of the results obtained, it is concluded that mebendazole represents a useful therapeutic approach provided it is administered in full doses and for a long period in well selected cases, namely patients with cysts of limited dimension and, probably, of comparatively recent onset.     

Spinal invasion of pulmonary hydatidosis: computed tomographic demonstration

A case of pulmonary hydatidosis in which cysts caused spinal cord compression is presented. To our knowledge, spinal invasion after pulmonary hydatidosis has not been demonstrated previously.     

Comparison of biomechanical and structural properties between human aortic and pulmonary valve.

OBJECTIVE: Pulmonary valve autografts have been reported as clinically effective for replacement of diseased aortic valve (Ross procedure). Published data about pulmonary valve mechanical and structural suitability as a long-term substitute for aortic valve are limited. The aim of this study was to compare aortic and pulmonary valve properties. METHODS: Experimental studies of biomechanical properties and structure of aortic and pulmonary valves were carried out on pathologically unchanged human heart valves, collected from 11 cadaveric hearts. Biomechanical properties of 84 specimens (all valve elements: cusps, fibrous ring, commissures, sinotubular junction, sinuses) were investigated using uniaxial tensile tests. Ultrastructure was studied using transmission and scanning electron microscopy. RESULTS: Ultimate stress in circumferential direction for pulmonary valve cusps is higher than for aortic valve (2.78+/-1.05 and 1.74+/-0.29 MPa, respectively). Ultimate stress in radial direction for pulmonary and aortic cusps is practically the same (0.29+/-0.06 and 0.32+/-0.04 MPa, respectively). In ultrastructural study, different layout and density in each construction element are determined. The aortic and pulmonary valves have common ultrastructural properties. CONCLUSIONS: Mechanical differences between aortic and pulmonary valve are minimal. Ultrastructural studies show that the aortic and pulmonary valves have similar structural elements and architecture. This investigation suggests that the pulmonary valve can be considered mechanically and structurally suitable for use as an aortic valve replacement.     

胸腔镜下双肺包虫一期手术内囊摘除19例

目的探讨胸腔镜下一期手术行双肺包虫内囊摘除术的临床疗效。方法接受胸腔镜下治疗的双侧肺包虫患者19例。全身麻醉,双腔气管插管,单肺通气。先行左侧手术,胸部取3个1.5 cm小切口,高渗盐水纱布垫术中于穿刺点以下及周围保护胸腔,三通针头于内囊最高点处穿刺,吸净囊液后,切开外囊壁,切除内囊置于标本袋中从胸腔移出,然后重新摆体位行右侧手术。结果手术时间115~195分钟,平均152分钟;出血150~300 nml,平均出血195 ml,术后住院时间8~20天,平均10.3天;漏气2例,其中单侧1例,双侧1例;脓胸1例;19例患者随访1~5年,平均2.3年,无复发患者。结论胸腔镜下双肺包虫一期手术内囊摘除术安全,有效,创伤小、并发症少。     

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.     

Experience in the surgical treatment of 331 patients with pulmonary hydatidosis

Echinococcus disease is prevalent in Chile, with a rate of occurrence of 8.2 per 100,000. During a 15-year-period (1970 to 1985) we operated on 331 patients for pulmonary hydatidosis. Chest roentgenography was the main method of diagnosis. Among the total of 508 surgical procedures performed, pulmonary cystectomy was the most common (61.4%), whereas pulmonary resection was used in 31.4% of patients. The arc 5 test was used to confirm the diagnosis. Results were positive in 85% of the patients in whom it was done. There were 12.9% immediate postoperative complications in 12.9%, with late complications occurring in 4.10% and an overall mortality rate of 4.21%. These data suggest that hydatid cyst is still a common disease in our country, causing an important number of hospital admissions and a high percentage of complications.     

Surgical treatment for pulmonary hydatidosis (a review of 422 cases)

OBJECTIVE: Hydatidosis in man is frequently encountered in sheep and cattle raising regions of the world. We reviewed 422 patients, treated surgically for pulmonary hydatid disease in our clinic between January 1980 and January 1998, assessing the clinical features and results of results of operative treatment management in our centre. PATIENTS AND METHODS: 52 of the patients were female and 370 were male. The median age of the patients was 33 years (range, 11 to 66 years). The cysts were located in the right lung in 214 (50.7%) patients, the left lung in 156 (37%) and bilaterally in 17 (4%) cases. We found an intrathoracic extrapulmonary cyst in 35 (8.3%) patients. We performed enucleation and capitonnage in 202 cases, wedge resection in 40, cystotomy and capitonnage in 171, and lobectomy in 9 patients. The high-risk patients were treated with Albendazol (10 mg/kg/day), for a period of 3 months postoperatively. RESULTS: Preoperative diagnosis was based primarily on chest roentgenograms and led to correct diagnosis in 347 cases (82.2%). An additional computerised tomography (CT) scan in 56 cases and magnetic resonavive imaging (MRI) were required in 15 cases. The diagnosis is established intraoperatively in 4 cases. Most (296) patients presented with a solitary lung cyst. The rest were found to have multiple cysts in one or more lobes. 87 of 422 also had cysts in the liver, 19 in the spleen, and 1 in the pancreas. The follow-up data was completed in 392 of 422 (92.8%) patients. The mean follow-up period was 4.3 years (2 to 19 years). We detected recurrence in 3 patients (0.71%). CONCLUSION: The effective treatment of hydatid cyst(s) in the lung is complete excision of the cyst(s) with maximum preservation of the lung parenchyma. Additional medical treatment with Albendazole should be carried out for high-risk group patients.