揂ir Bubble Sign� and Fibreoptic Bronchoscopy in Complicated Pulmonary Hydatid Cysts: Steps in the Right Direction

Intact pulmonary hydatid cysts are often discovered incidentally on chest X-rays (CXRs) as rounded opaque lesions with smooth borders. Cyst rupture and infection (complicated hydatid cyst) often change the radiologic appearance delaying diagnosis. Air bubble sign on computed tomography is recognized as a sign of high sensitivity and specificity in the diagnosis of complicated hydatid cysts when compared to other classical radiologic signs. Bronchoscopy is not a preferred investigation in patients with intact hydatid cysts but may have a major role in patients with complicated hydatid cysts with atypical presentation. In the present case series, we attempt to highlight the importance of the 揳ir bubble sign� and the identification of a whitish membrane at bronchoscopy in the diagnosis of complicated hydatid cysts.

Cystectomy With or Without Capitonnage: Analysis of Outcome of 73 Cases in the Management of Hydatid Cyst of Lung

Introduction: Sporadic cases of lung hydatid cyst is commonin India apart from its endemicity in Mediterranean regionsand other rural areas of developing countries. The patients ofHydatid cyst (HC) of lungs are often diagnosed incidentally.The definitive treatment of such lesions is surgery. Lungpreserving surgery in such cases is generally the preferredtechnique unless there is considerable destruction ofpulmonary parenchyma. Cystotomy and capitonnage arethe two preferred techniques and generally followed. In thisretrospective observational study it was attempted to analyzeoutcomes of cystotomy and capitonnage with regard topostoperative morbidity and mortality.Material and Methods: Between 1st May 2014 and 31stMay 2019, a total of 73 patients with lung Hydatid cyst wererandomly selected from all the hydatid cyst cases operated in atertiary centre and the results and outcome analyzed. Out of 73cases 39 (Group A) were operated by Cystotomy and closureof bronchial opening and 34 (Group B) were operated withCystotomy, closure of bronchial opening and Capitonnage.Results: The mean chest tube removal time for Group A andB was 5.94 ± 3.17 and 3.41 ± 2.61 days respectively. Themean hospital stay was 10.02 ± 4.53 days for group A and7.55 ± 2.66 days for group B. Prolonged air leak (>7days)was found in 15 patients in group A, 14 of which requiredprolonged chest tube drainage and 1 required surgical closure.4 patients in group B had prolonged air leak and all closedwith prolonged chest tube drainage. No abscess formation ormortality was observed in any group in this study. There wasa significant difference between group A and group B withregard to chest tube removal time (P=0.000836), hospital stay(P = 0.047585), and all complications (P= 0.008214).Conclusion: In surgical management of pulmonary Hydatidcyst, capitonnage is superior to cystotomy without capitonnagebecause it reduces morbidity and hospital stay.

A Case of Pulmonary Hydatid Cyst Misdiagnosed as Encysted Effusion

Echinococcosis or hydatid disease is caused by larvae of the tapeworm Echinococcus. In cystic echinococcosis, humans are an accidental host and are usually infected by handling an infected dog. The liver and lungs are the most frequently involved organs. Pulmonary disease appears to be more common in younger individuals. Although most patients are asymptomatic, some may occasionally expectorate the contents of the cystor develop symptoms related to compression of the surrounding structures. Other symptoms of hydatid disease can result from the release of antigenic material andsecondary immunological reactions that develop from cyst rupture.

Quince años de experiencia clínica con hidatidosis / Clinical presentation of hydatid disease during 15 years: a case series from Santiago, Chile

Introduction: Hydatidosis is a neglected parasitic disease that is endemic in Chile. We present the clinical experience of a single center in Santiago from 1996 to 2010. Methods: Cases were identified using hospital's database. Clinical and pathological features, treatment and outcomes were retrospectively analyzed. Results: In total, 23 patients were identified requiring 30 surgical interventions. Median age was 40 years old (range 5 to 73), and 76.5% visited or resided in regions of known endemicity in Chile. Abdominal cysts were predominant (78.3%), and most patients were symptomatic (73.9%). Elimination of cyst material by cough was reported in 42.9% of patients with symptomatic thoracic cysts. Eosinophilia was present in 41.2% of patients, and 57.1% had positive serology for hydatidosis. Aill patients underwent surgical treatment, in 60.9% in combination with albendazole treatment. While the majority of liver cysts (88.9%) were treated by complete cyst resection, lung cysts (83.3%) were predominantly treated by cyst resection plus capitonnage. Pathological examination revealed fertile cysts in 24%. Postsurgical morbidity was frequent (37.9%), and 13.3% of the series required readmission for this cause. Near 25% of patients remained in hospital > 14 days, a feature associated with fever during admission (p < 0.05). No recurrence was reported in the fraction of patients that were followed-up for 2 years or more. Conclusions: Our analysis of 23 cases demonstrates that patients were mainly adults suffering from abdominal cysts. Most patients were successfully treated by surgery with or without antiparasitic drugs but complications leading to prolonged hospital stays and readmissions were not infrequent.

Introducción: La hidatidosis es una enfermedad endémica en Chile. Se presenta la experiencia clínica de un hospital en Santiago, desde 1996 al 2010. Métodos: Los casos fueron identificados usando las bases de datos institucionales y se analizaron las características clínicas y patológicas, el tratamiento y la evolución en forma retrospectiva. Resultados: Se identificaron 23 pacientes intervenidos en 30 oportunidades. La mediana de edad fue de 40 años (rango 5 a 73) y 76,5% visitó o residía en zonas endémicas en Chile. Los quistes abdominales fueron predominantes (78,3%) y la mayor parte de los pacientes eran sintomáticos (73,9%). Un 42,9% de aquellos con quistes sintomáticos torácicos reportó eliminación de vesículas con la tos. Un 41,2% presentó eosinofilia y 57,1% tuvo serología positiva para hidatidosis. Todos los pacientes fueron tratados quirúrgicamente, en 60,9% en combinación con albendazol. La mayoría de los quistes hepáticos fueron tratados con cirugía radical (88,9%) y los pulmonares predominantemente con quistostomía y capitonaje (83,3%). Un 24% de los quistes eran fértiles. La morbilidad post-quirúrgica fue frecuente (37,9%) y 13,3% de la serie requirió reingresos por esta causa. Cerca de 25% de los pacientes estuvo hospitalizado por más de 14 días, un fenómeno asociado con la presencia de fiebre por complicación séptica al ingreso (p < 0,05). No se registraron recurrencias en la fracción de pacientes seguidos por más de dos años. Conclusiones: La hidatidosis afecta principalmente a adultos en su cavidad abdominal. Aunque los pacientes fueron tratados exitosamente con cirugía, las complicaciones, estadías prolongadas y reingresos por esta causa no fueron infrecuentes.

Pulmonary hydatid cyst in Thai: A report of first case.

The first case of Pulmonary Hydatid Cyst at the Central Chest Hospital was recently found in a Thai male presenting with haemoptysis. His chest x-ray revealed a round mass (2.5x3.5 cm) with distinct border at the anterior segment of the left upper lobe. The diagnosis of lung cyst was made by ultrasonography. Examination of aspirated cyst fluid revealed Echinococcus granulosus parasite. Left thoracotomy was performed to remove the cyst; there was no post-operative complication.