The Evaluation of 13 Patients with Intrathoracic Extrapulmonary Hydatidosis

Intra thoracic extra pulmonary hydatidosis: prognosis and outcomes of 8 operated patients

Hydatid cyst disease is a parasitic disease known from the times of hippocrates, and is still endemic in our country Morocco among others, affecting mainly the liver and lungs, while intra thoracic extra pulmonary location remains a rare entity of the disease. In our department of thoracic surgery, Mohamed VI University Hospital, Oujda, Morocco, we operated 92 patients for thoracic hydatid cyst in the period between January 2016 and December 2021, 8 patients of this group had exclusive extra pulmonary location of the hydatid cyst, epidemiological and clinical data were recorded for the 8 patients (5 men, 3 women). The mean age was 40.3 years, all patients presented mainly with chest pain, dyspnea and cough. The locations of the hydatid cysts were chest wall, pericardium, pleural space and diaphragm. The hydatid cysts were removed via extirpation technique through thoracotomy in all patients. The average duration of hospitalization was 7 days. Postoperative complications consisted of atelectasis in one patient, parietal hematoma in another, and surinfection with pleuro-cutaneous fistula and chronic neurological chest pain in one patient. No deaths were noted in our series.

A giant pulmonary cyst hydatid imitating plevral effusion

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Cystic echinococcosis is a zoonosis which have detrimental effects on public health.

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The basic treatment for cystic echinococcosis is surgery, with possible risk of anaphylaxis and secondary echinococcosis.

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Postoperative antihelminthic therapy is preferred to prevent postoperative complications.

Introduction

Cystic echinococcosis is an endemic disease in east Turkey. Echinococcosis granulosus is reported as the most common agent of cystic echinoccocus. Hydatid cysts are generally involved in lung and liver.

Presentation of case

37 year old female admitted to our clinic with cough and expectoration of watery material progressing within 3 months. Thorax CT demonstrated a 110*100 mm well defined cavitary lesion in the right lower lobe of the lung. The patient was treated with cystotomy & capitonnage and postoperative albendazole treatment successfully.

Discussion

Hydatid cysts should be conceived in differential diagnosis of pulmonary cystic lesions.

Conclusions

The basic treatment for cystic echinococcosis is surgery. Postoperative antihelminthic therapy is preferred to prevent postoperative complications.

[Head and neck localizations of hydatid cyst: A series of 17 cases]

INTRODUCTION

Head and neck localizations of hydatid cyst are very rare (1% of human cases) even in countries where echinococcosis is endemic (human sites). Our objective was to report the epidemiological, and clinical characteristics and the management of head and neck localizations of hydatid cyst.

MATERIALS AND METHODS

A retrospective descriptive study of 17 cases of head and neck hydatid cysts taken in charge in our department between 2000 and 2014 was conducted.

RESULTS

The mean age was 35 years. Male were slightly predominant (sex ratio: 1.12). Eighty-eight percent of the patients had regular contact with dogs and 53% were of rural origin. The soft tissues of the head and neck were involved in six patients, the parotid gland in 6 patients, the thyroid in 4 patients and the submaxillary gland in one patient. Complete surgical resection of the lesions was systematically done. Hydatid disease was confirmed in all the cases by histology. The outcome was uneventful in all the patients with a mean follow-up of 2 years.

CONCLUSION

Given the lack of recommendations for the surgical treatment of head and neck hydatid cysts, we advocate a total resection of the affected organ if there is no functional risk. Otherwise, an excision of the cyst and of the surrounding tissues combined with an abundant washing-out of the residual cavity must be done, especially in case of intraoperative breaking of the cyst.

[Hydatid disease of the ribs]

OBJECTIVES

Hydatid disease is a zoonosis resulting from the growth in man of the larval form of Echinococcus granulosus. Involvement of the bones is rare and localisation to the ribs is exceptional. The aim of our study is to present the pathophysiological and diagnostic characteristics of hydatid disease of the ribs and to define the radiological features.

PATIENTS AND METHODS

We undertook a retrospective study, over a period of 10 years, of 12 cases of hydatid rib disease. We have analysed the demographic, clinical and biological parameters and we examined the radiological details as well as the effect of surgery on the progress of the disease.

RESULTS

The mean age of the patients was 33.5±10 years. There was no sexual predominance. The clinical picture was characterised by chest pain in ten cases and by swelling in five. General health was satisfactory in all patients. The chest X-rays showed a shadow of water density with lytic rib lesions. Thoracic CT scans showed the relationships with the neighbouring structures, particularly the spinal column. In three cases T1- and T2-weighted MRI scans showed the extent of intraspinal extension and in two cases excluded medullary involvement. Hydatid serology was positive in five cases. All our patients were operated on, with rib resection and vertebral curettage in three cases, and resection of the transverse process in two. Histological examination of the surgical specimens confirmed the diagnosis. Eight patients were treated with albendazole. All patients were reviewed for a mean of 3 years and the progress was favourable.

CONCLUSION

Hydatid disease of the ribs is a very rare disorder and the diagnosis is difficult. It is sometimes an unexpected surgical finding but careful examination of the chest X-ray, supplemented by a CT scan, thanks to the liquid density of the lesions, is a great help in diagnosis. However, in the light of the results of our series, the radiological picture may be atypical and the interpretaion difficult.

[Hydatid cyst of the chest wall mimicking metastatic colon cancer]

Chest wall hydatidosis, rare even in the endemic countries, represents 0.09 to 0.3 % of all cases of thoracic echinococcosis. The authors report the case of a 76 year-old man presenting a chest wall mass 4 years after surgery for colic carcinoma. The mass presented both hypoechoic and hyperechoic structures in the ultrasound chest echography. Therefore, metastastic colon cancer was suspected. The pathological study of the mass revealed hydatid membranes. Thoracic tomodensitometry supported the diagnosis of costovertebral and soft tissue hydatid cysts. The patient underwent the surgical resection of two rib arches, a transverse apophysis and the neighbouring soft tissue associated with pre- and post-surgical albendazole. No clinical manifestations were noted in the follow-up after 1 year.

[Multiple extrapulmonary thoracic hydatidosis]

INTRODUCTION

Extrapulmonary intrathoracic hydatid cysts are unusual but they may be multiple, particularly during a secondary dissemination. With the aim to clarify the origins of this dissemination, we report our experience in the treatment of multiple thoracic extrapulmonary hydatidosis (MTEH).

MATERIAL AND METHODS

Between January 1995 and December 2004, 41 patients were operated on for MTEH in our department. Chest roentgenogram and computed tomography were the main means of diagnosis. The treatment consisted of total surgical removal of the intact cysts. The approach was a postero-lateral thoracotomy (right in 29 cases, left in 8 cases, bilateral in 3 cases) and a median sternotomy in one case. All patients received complementary medical treatment with Albendazol.

RESULTS

The MTEH was secondary to haematogenous dissemination in 6 patients (15%), to a hydatid cyst of the lung in 7 patients (17%) and to a hydatid cyst of the liver in 28 patients (68%). 75% of these patients had had a previous surgical intervention for hepatic cyst and 88% of them had diaphragm involvement. There were no deaths among our patients but the recurrence rate was 12%.

CONCLUSION

Secondary intrathoracic extrapulmonary hydatidosis is generally seen among patients operated on for hydatid cyst of the liver. Necessary precautions must be taken at the time of surgery to avoid any intrathoracic dissemination.