Thoracic hydatid cysts: an analysis of surgical management in a tertiary care centre in India

Treatment of pulmonary hydatid cysts: a single-centre analysis of 872 cases

OBJECTIVES

The objective of this study was to investigate the importance of pulmonary parenchyma preservation, the results of cystotomy and the capitonnage technique and the efficacy of postoperative albendazole treatment.

METHODS

A retrospective study was conducted at a single centre between 2000 and 2024, encompassing 872 consecutive patients with pulmonary hydatid cysts.

RESULTS

Of the cases studied, 394 (45.2%) were female and 478 (54.8%) were male, with a mean age of 26.8 ± 19.7 years (range: 2-86 years). Isolated lung involvement was observed in 553 (63.4%) cases. In general, a single hydatid cyst was detected in 665 (76.3%) patients, and 466 (53.4%) of these had isolated lung involvement. In 452 cases (51.8%), only the right lung was affected, whereas 294 (33.7%) had left lung involvement, and 126 (14.5%) had bilateral lung involvement. An operation was performed in 807 (92.5%) cases. Cystotomy and capitonnage were performed in 782 (89.7%) patients. Thoracoscopic wedge resection was performed in 13 cases (1.5%), cystotomy alone in 5 cases (0.6%), lobectomy in 5 cases (0.6%) and enucleation with capitonnage in 2 cases (0.2%). Postoperative complications included atelectasis in 45 cases (5.6%), prolonged air leak in 8 cases (1.0%), empyema in 6 cases (0.7%), wound infection in 3 cases (0.4%) and bleeding in 2 cases (0.2%). Recurrence was observed in 4 (0.5%) surgically treated cases, and 1 case (0.1%) resulted in death in the postoperative period.

CONCLUSIONS

The management of pulmonary hydatid cysts with cystotomy and capitonnage is feasible in the majority of patients and results in acceptable success and complication rates. Administration of albendazole postoperatively has been shown to be an effective method of preventing recurrence.

Factors associated with hospital length of stay in patients with thoracic hydatid cyst disease undergoing surgical intervention: a retrospective study

BACKGROUND

Hydatid cyst (HC) frequently affects the lungs, making it the second most common site after the liver. This study evaluated the clinical characteristics, surgical procedures, complications, laboratory findings, and factors influencing hospital length of stay (LOS) in patients undergoing surgery for pulmonary hydatid cysts.

METHODS

This retrospective observational study included adult patients who underwent surgery for lung HC between 2017 and 2021. Data were collected using a standardized checklist covering demographics, medical history, clinical symptoms, laboratory findings, treatment details, surgical characteristics, and risk factors. The primary outcome was LOS, defined as the duration between surgery and discharge.

RESULTS

A retrospective analysis of 214 patients with pulmonary hydatid cysts revealed a male predominance (59.3%; median age, 36 years). The most common symptom was cough (39.3%), followed by chest pain and dyspnea. Right lower lobe involvement (51.4%) and synchronous liver cysts (13.6%) were frequently observed. Elevated erythrocyte sedimentation rate (ESR), eosinophilia, positive serology, prolonged air leak, and fever were correlated with longer LOS. The dominant surgical procedure was cystotomy with capitonnage (95.8%), performed via thoracotomy.

CONCLUSIONS

Most hydatid cysts were located in the right lower lobe, with cough being the most frequent presenting symptom. Thoracotomy and cystotomy with capitonnage were the primary surgical procedures performed. Common postoperative complications included wound infection, empyema, and prolonged air leak. Awareness of factors such as elevated ESR, eosinophilia, positive serology, prolonged air leak, and fever may improve management and reduce hospital LOS.

An overview on the principles of management of haemoptysis

Haemoptysis is a frequently encountered presentation in thoracic surgery practice. Most of the patients present with chronic haemoptysis while 5% of them will present with life-threatening acute haemoptysis. Emergency surgery used to be the first-line management in acute life-threatening haemoptysis which resulted in significant morbidity and mortality. With advancements in interventional procedures, most of these acute presentations are now being managed conservatively by interventionists. In a country like India with a high incidence of tuberculosis and other infectious diseases of the lungs, haemoptysis is even more common. While interventional procedures help to tide over the crisis and earn valuable time to stabilise a haemorrhaging patient, surgical resection is the definitive management most of the time. This review will endeavour to establish the definition, aetiology, emergency, and definitive management of a patient who presents with haemoptysis.

Surgical excision for gigantic bilateral pulmonary hydatid cyst in a 14-year-old adolescent: A case report study

INTRODUCTION AND IMPORTANCE

Bilateral pulmonary hydatid cysts in adolescents are rare and present unique diagnostic and treatment challenges. Adolescents with pulmonary hydatid disease often present with nonspecific symptoms such as cough, abdominal pain, nausea, vomiting, and hepatosplenomegaly.

CASE PRESENTATION

This case is about 14-year-old adolescent who reported feeling a mass in his chest and experienced a loss of appetite. Imaging studies were performed which showed the presence of bilateral hydatid cyst in the lung. The cyst contents were sent for histopathological analysis, which confirmed the diagnosis of hydatid cysts.

CLINICAL DISCUSSION

The clinical presentation of hydatid cysts varies depending on the organs involved. Bilateral hydatid cysts may occur in various organs such as liver, lung, brain, spleen, kidney, bone and other sites. Diagnosis of bilateral hydatid cysts in adolescents is difficult because symptoms may be nonspecific and the cysts may not be apparent until they reach a sufficient size. The type of surgical approach depends on the location, size, and number of cysts.

CONCLUSION

Bilateral pulmonary hydatid cysts have become an increasingly important diagnosis in adolescent patients. Imaging plays a critical role in prompt diagnosis, and surgical intervention remains the mainstay of management. There are limited studies regarding the management of such rare cases, but through a multidisciplinary approach, improved outcomes can be achieved.

Aspergilloma in a hydatid cavity

Fungal colonization by aspergillus usually occurs in pre-existing lung cavities mostly due to post-tubercular sequelae. Colonization of a hydatid cavity is very rare. We hereby report this unusual co-infection in a 55 years old diabetic male patient who was diagnosed pre-operatively and was managed with surgery, anti-fungal agents, and anthelminthics. The possibility of this co-infection should make clinicians more vigilant in managing hydatid cysts in diabetics and immunocompromised, as they may have concomitant fungal infestation of the hydatid cavity.