Primary Intrathoracic Extrapulmonary Hydatid Cysts: Analysis of 14 Patients with a Rare Clinical Entity

Primary hydatid cysts very rarely form in intrathoracic yet extrapulmonary sites. Accurate preoperative diagnosis in such cases is difficult, and corrective surgical procedures necessarily differ from those that are used to treat the far more typical pulmonary or hepatic hydatid cysts. We retrospectively evaluated the diagnostic and operative characteristics of intrathoracic extrapulmonary hydatid cysts, and we examined the outcome of aggressive surgical interventions that went beyond conventional parenchymal-sparing procedures.From 2003 through 2007, 14 patients (mean age, 39.14 ± 16.8 yr) underwent surgical treatment in our hospital for primary intrathoracic extrapulmonary hydatid cysts. These cysts were variously in the diaphragm, chest wall, mediastinum, pleura, and pericardial cavity. All patients underwent cystectomy, decortication, resection, and repair of the adjacent structure. No complication, recurrence, or death occurred in the follow-up period of 15 ± 18.1 months (range, 2–52 mo).In order to achieve complete resection and to avoid recurrence of disease from intrathoracic extrapulmonary hydatid cysts, the thoracic surgeon should forgo cystotomy and capitonnage in favor of cystectomy with a wide resection and reconstruction of surrounding tissues. Postoperatively, patients should adhere to a regimen of anthelmintic therapy.Key words: Anthelmintics/therapeutic use, echinococcosis/complications/diagnosis/radiography/surgery, incidence, recurrence, retrospective studies, thoracic diseases/diagnosis/parasitology/surgery, thoracic surgical procedures, operative/methods, treatment outcome, Turkey/epidemiologyHydatid cyst disease, or echinococcosis, is a parasitic disease that has been known since the time of Hippocrates. It remains endemic in Turkey and other countries. Although the liver and the lungs are the usual sites of the disease, cysts can also form elsewhere in the body.^1,2 It is not difficult to diagnose typical pulmonary or hepatic hydatid cysts. Conversely, when cysts appear intrathoracically but in extrapulmonary locations, crucial diagnostic difficulties may occur, with atypical clinical and radiologic signs. Cysts in such sites can lead to fatal complications, such as bronchial rupture, fistulas to the pleural and pericardial cavities, and severe bleeding.^3,4 Difficulties in diagnosis notwithstanding, corrective surgical treatment differs from that of pulmonary or hepatic hydatid surgery.In this retrospective analysis, we evaluated the characteristics of intrathoracic extrapulmonary hydatid cysts and sought to confirm the most appropriate surgical interventions. This study was approved by our institution''s ethics committee.