PULMONARY HYDATID CYST

PROF.N.NAGARAJAN MCHDEPT OF CARDIOTHORACIC SURGERY

STANLEY MEDICAL COLLEGECHENNAI

CASE REPORT• 60 YEAR OLD FEMALE• C/O DRY COUGH, DYSPNOEA, NONSPECIFIC CHEST PAIN OF

RECENT ONSET• NO H/O PT /HAEMOPTYSIS/ FEVER• O/E PT AFEBRILE, NOT ANAEMIC, NOT DYSPNOEIC, NO CYANOSIS/CLUBBING PULSE/BP/SPO2 --- NORMAL CVS/RS ---- NO CLINICAL FINDINGS ABD ---- NO ORGANOMEGALY

INVESTIGATIONS

• X-RAY CHEST PA --- CYST LOWER LOBE RT LUNG• CT SCAN CHEST --- LARGE SMOOTH CYST

(WITH THICKENING OF WALL) ABUTTING THE HILUM

• USG ABDOMEN --- NO HEPATIC or SPLENIC or VISCERAL HYDATID CYSTS

DIFFERENTIAL DIAGNOSIS• CONGENITAL: BRONCHOGENIC CYST PULMONARY SEQUESTRATION CYSTIC ADENOMATOID MALFORMATION• INFECTIOUS: PULMONARY TUBERCULOSIS COCCIODOMYCOSIS PNEUMOCYSTIS CARINII ECHINOCOCCOSIS• LAM (LYMPHANGIOLEIOMYOMATOSIS)

•

HYDATID MEMBRANES

PULMONARY ASPERGILLOMA

LUNG ABSCESS

HISTORY

• 1687 – BARTHOLIN DESCRIBED CYSTIC LUNG• 1925 – KOONTZ POSTMORTEM COLLECTION

OF CONGENITAL CYSTS

HYDATIDOSIS

• Echinococcosis is a human disease caused by the larval form of Taenia echinococcus

Definitive hosts --- DOGS (canides)Intermediate hosts --- Domestic and wild

animals ( Humans – Accidental)E granulosus causes cystic echinococcosis

worldwideE multilocularis causes alveolar echinococcosis in

Arctic regions

CLINICAL FEATURES

• INCIDENCE Rural > Urban Male:Female ----- 5:1 Lower lobes R>L• Solitary small simple peripheral cyst ---

asymptomatic• Symptoms: chest pain, cough, haemoptysis,

dyspnoea, fever, salty sputum, allergy, sudden collapse (in complicated cysts)

POMEGRANATE SHAPED CYST

WATER LILY APPEARANCE (RUPTURED CYST)CAMALOTE SIGN

INVERSE CRESCENT SIGN (MEMBRANE SEPARATION)

THICKENED WALL (INFECTION)

SIGNET RING SIGN (IMPENDING RUPTURE)

HUGE CYST LT HEMITHORAX

Types

• Type I ---- Single cyst• Type II --- Mature cyst with daughter cysts• Type III – Inert mummified and calcified cyst• Simple/ complicated ( Rupture, Infection)

Complications• Compression --- Restrictive and Obstructiive

changes - Rarely chronic PHT• Rupture -- allergic symptoms and anaphylaxis

-severe hypotension and death• Rupture - transbronchial spread to other

lobes/ pleural hydatidosis/ pleural effusion/ systemic hydatidosis

• Infection -- abscess formation and septicemia• Calcification - rare

MANAGEMENT

• Small cyst< 2-3 cm-----Medical treatment –Albendazole- 3-4 weeks

• Larger cysts>4-6 cm---- Surgical resection• IF THE HYDATID CYST OCCUPIES MORE THAN

50% OF A LOBE ----- LOBECTOMY• Aspiration/ Hypertonic saline injection---carry

the high risk of anaphylaxis