[Hydatic pulmonary embolism: a rare complication of hepatic hydatid cyst]

Four pathways for hydatid pulmonary embolism

INTRODUCTION

Hydatid pulmonary embolism (HPE) is rare but remains an etiology that needs to be considered and kept in mind, especially in endemic areas, as regards nonthrombotic embolism.

METHODS

Between 2000 and 2014, 10 patients were treated in our department for the presence of hydatid material in the pulmonary arterial circulation. Through these 10 cases, we try to assess the radioclinical characteristics and results of the surgical treatment.

RESULTS

The study included six men and four women, average age 28 years. Discovery of HPE was made following the exploration of cardiorespiratory symptoms in nine cases and was incidental in a single patient. Computed tomography angiography (CTA) of the chest directly visualized the hydatid material in the pulmonary arteries in nine cases. Surgery consisted of an embolectomy under cardiopulmonary bypass in nine cases. This embolectomy was preceded by the treatment of an embolic hydatid cyst (HC) in seven cases (HCs of the right heart chambers in six cases and a liver HC ruptured in the inferior vena cava in one case), whereas for only one patient, who presented a HC pedunculated in the right ventricle and protruding into the pulmonary artery, the cure of the cardiac location was sufficient. Only one patient died on the third postoperative day.

CONCLUSION

Endoluminal hydatid involvement of pulmonary arteries is extremely rare. CTA chest has an important contribution to the positive diagnosis. Treatment is surgical when the patient's condition allows it.

Pulmonary Embolism as a Rare Complication of Liver Hydatid Cyst: Report of Two Cases

Hydatid cyst is a helminth infection. The rupture of a hepatic hydatid cyst in inferior vena cava is a rare and lethal complication. Pulmonary embolism is the commonest manifestation. The diagnosis of hydatid cyst is made by histopathological or serological examination, and imaging may suggest the probability of hydatid cyst. Surgical treatment should be performed with caution and always under vascular control. We present two cases of hydatid cyst ruptured into the inferior vena cava. The patients also presented with dyspnea, hemoptysis, and intermittent cough at the time of admission. This presentation will be accompanied by a brief review of the literature. The radiological findings suggested the diagnosis. The first patient had a fatal hydatid pulmonary embolism and death occurred on the second day of hospitalization. The second patient refused surgery. These cases also exemplify the clinical and radiographic findings as well as the management of this complication.

[Pulmonary hydatid cyst: unusual double apical location. About a case]

Le kyste hydatique (KH) est une pathologie encore endémique dans plusieurs pays notamment dans notre contexte marocain. L’atteinte pulmonaire vient au second plan après l’atteinte hépatique. Elle se caractérise par la richesse des tableaux anotomo-cliniques et la possibilité de localisations multiples dans le parenchyme pulmonaire, prédominant essentiellement aux bases. Nous rapportons le cas de Mr J.M, âgé de 54 ans, admis pour suspicion de kyste hydatique pulmonaire devant une douleur thoracique évoluant depuis 6 mois et un épisode d’hydatidoptysie. La radiographie thoracique a objectivé une image particulière de double localisation apicale illustrant en un même cliché des différents stades évolutifs du kyste hydatique pulmonaire. Le diagnostic était confirmé par la TDM thoracique et la sérologie hydatique. La localisation multiple du kyste hydatique pulmonaire n’est pas une situation rare dans les pays à forte endémie hydatique. Notre cas clinique rapporte une double localisation apicale inhabituelle du kyste hydatique et à des stades évolutifs différents.