The co-infection of pulmonary hydatid cyst, lophomoniasis and tuberculosis in a patient with resistant respiratory symptoms; a case report study.

BACKGROUND: Lophomonas blattarum is a rare protozoan that causes opportunistic infections, and the co-infection of lophomonas with tuberculosis and human hydatidosis is a serious public problem in the co-endemic areas of developing countries. CASE REPORT: We presented a 58-year-old female with fever, losing weight, and cough with whitish-yellow sputum that started one month ago. Increasing inflammatory markers and hypereosinophilia in laboratory tests, and a cavity with thick, regular walls and undulating air-fluid levels measuring 43 × 30, evident in the upper segment of the right lower lobe (RLL), along with consolidation and the ground glass opacity of the upper segment and posterior basal of the RLL is apparent in CT scan were reported. Then, a bronchoscopy was requested, and the BAL specimen reported a negative fungal and bacterial infection in the samples. Several live and oval flagellated lophomonas protozoa, hydatid cyst protoscoleces (the larval forms of the parasites), and M. tuberculosis were observed in microscopic evaluation. The patient was treated with metronidazole, oral albendazole, and a combination of TB regimen. CONCLUSION: Physicians should always consider the possibility of co-infections of lophomonas with tuberculosis and human hydatidosis and investigate patients with risk factors such as immunodeficiency conditions or treated with immunosuppressive medications.

Basic Operative Tactics for Pulmonary Echinococcosis in the Era of Endostaplers and Energy Devices.

Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species Echinococcus. The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed.

Concomitant Pulmonary Cystic Echinococcosis and Aspergillosis in a Male Child.

Co-infection of cystic echinococcosis and aspergillosis is a rare finding. The patient was a 10-year-old boy complaining of chest pain and malaise with a cyst in the right lung who underwent surgical resection of the cyst. Medical therapy with albendazole was started for the patient with the initial clinical impression of cystic echinococcosis. Later, the microscopic evaluation revealed a laminated layer of cystic echinococcosis involved by acute angle branching hyaline hyphae with septate. Thus, the diagnosis of a cystic echinococcosis and aspergillosis co-infection was established. Surgery is the mainstay of treatment along with anthelminthic and anti-fungal therapy, especially in immunocompromised patients.

Computed Tomography (CT) Findings of Pulmonary Hydatid Cysts in Children and the Factors Related to Cyst Rupture.

BACKGROUND The lungs are the most common site of hydatid cysts in children. Rupture is the main complication of cysts causing morbidity and mortality. In this study we aimed to comprehensively describe the CT signs for cysts and analyze the relationship of cyst ruptures to the diameter and location of cyst. MATERIAL AND METHODS A total of 145 cysts from 102 patients, aged 17 years or younger, who underwent a multi-detector computed tomography (MDCT) evaluation and had surgically proven pulmonary hydatid disease were included retrospectively. The CT images were analyzed for radiologic findings and signs of cyst rupture. RESULTS The cysts had a mean diameter of 5.45±3.03 cm. Most of the patients had a solitary cyst (70.6%). The most common lobes involved were the lower lobes (58.6%). Peripherally located cysts were more common than central cysts. The overall number of ruptured cysts was 69 (47.5%). The most common sign was the waterlily sign with a prevalence of 24.6%. After exclusion of cysts of 1 cm, the mean cyst diameter was 6.23±2.83 cm in the unruptured group and 5.02±2.80 cm in the complete ruptured group (p=0.020). The mean cyst diameter was 6.38±3.11 cm for centrally located cysts, and 4.31±2.37 cm for peripherally located cysts (p<0.0001). CONCLUSIONS Pulmonary hydatid cysts commonly presents as solitary cysts with a predilection for lower lobes and the peripheral regions of the lung. Peripherally located cysts are more common but smaller than centrally located cysts. Radiologists should also be aware of atypical imaging findings of cyst rupture, and radiologic signs should be explored during radiologic evaluation.

[A CASE OF FAMILIAL PULMONARY AND HEPATIC ECHINOCOCCOSIS)].

Echinococcus granulosus still remains a widespread disease. Moreover, there is a large number of patients in whom it is diagnosed rather late because its clinical presentation can be unspecific and symptoms vary. We report a familial case of the disease. Its specific feature was the onset with the bilateral pulmonary process and late involvement of the liver. This excluded other pulmonary diseases, such as pneumonia, tuberculosis or cancer.

Endosonography of a Pulmonary Artery Obstruction in Echinococcosis.

A 44-year-old woman with a history of pulmonary embolism and abdominal echinococcosis complained of sudden thoracic pain and shortness of breath. A D-dimer of 77.5 mg/l (reference ≤0.5 mg/l) was found. Chest CT scan revealed obstruction of the right lower and middle lobe pulmonary artery (PA). Anticoagulation therapy was initiated for the presumed diagnosis of recurrent pulmonary embolism. However, due to persistent symptoms of dyspnea, follow-up CT angiography of the chest was performed 3 months later. A persistent PA obstruction was found and the presumed diagnosis of embolism was questioned. Subsequently, endobronchial ultrasound (EBUS) imaging was performed to support an alternative diagnosis. EBUS imaging showed an inhomogeneous, sharply demarcated, intravascular lesion with round hypoechoic areas compatible with cysts. The diagnosis of embolism was rejected and treatment with albendazole was initiated for pulmonary echinococcosis. Echinococcosis is a parasitic disease and cystic spread in the PA is exceptional. The patient has remained stable for more than 4 years. In case of disease progression, including progressive PA obstruction or life-threatening hemoptysis, surgical resection will be considered.

[Endobronchial Ultrasound Guided Needle Aspiration of a Lung Cyst and Eosinophilic Pneumonia]. / EBUS-Punktion einer Lungenzyste und eosinophile Pneumonie.

We report the case of a young male patient with a solitary pulmonary echinococcus cyst. The diagnosis of Cystic Echinococcosis is based on clinical findings, imaging and serology. In the setting of lung cysts the diagnosis can be difficult, particularly as the sensitivity of the serologic tests is lower compared to liver cysts. Bronchoscopic ultrasound of the cystic lesion and respectively the analysis of the cyst aspirate can lead to the diagnosis. In the present case an eosinophilic pneumonia as the result of the puncture has to be discussed.

Rare reason for pulmonary embolism: one case of pulmonary hydatid cyst and review of the literature.

Pulmonary embolism due to hydatid disease has been rare clinically. Here we present a patient case who suffered from multiple cystic hydatidosis within bilateral lung parenchyma and complicated bilateral pulmonary embolisms. The case was a 70-year-old man who complained of an increasingly severe cough and hemoptysis post-operation of hepatic hydatid cyst. Chest radiographs showed that the patient had multiple nodules in the bilateral chest. Computed tomography (CT) depicted that some lesions were multivesicular cysts and some consisting of sophisticated complications. CT pulmonary angiography revealed bilateral pulmonary arterial embolisms. T2-weighted magnetic resonance images (MRI) clearly demonstrated the daughter cysts inside the lesions with high intensive signal. Echinococcosis serologic testing was positive. Thus, the pulmonary embolism was caused by hydatid cyst based on the imaging findings and serologic test.

Pulmonary Echinococcus multilocularis metastasis in a dog.

A young adult Labrador retriever dog was presented for surgical debulking of hepatic alveolar echinococcosis. Computed tomography detected hepatomegaly with multiple large cavitary masses with extension of tissue from a lesion wall into the caudal vena cava and numerous nodules in all lung lobes. Following euthanasia, histology confirmed parasitic vesicles with granulomatous reaction in all lesions, and polymerase chain reaction (PCR) established the causative agent to be Echinococcus multilocularis. This report is the first to present imaging features of pulmonary E. multilocularis granulomata in a dog.

Métastases pulmonaires d'Echinococcus multilocularischez un chien. À l'examen par tomodensitométrie d'un Labrador retriever jeune adulte référé pour résection de lésions hépatiques d'échinococcose alvéolaire, une hépatomégalie avec présence de larges masses cavitaires fut mise en évidence, de même que l'extension de la paroi d'une lésion à l'intérieur de la veine cave caudale, et de nombreux nodules pulmonaires. Après euthanasie, des vésicules parasitiques associés à une réaction granulomateuse furent confirmés histologiquement dans toutes les lésions évaluées, et E. multilocularis fût démontré par PCR être l'agent causal. Ce rapport de cas est le premier à présenter les caractéristiques de lésions pulmonaires d'E. multilocularis chez le chien.(Traduit par les auteurs).

Brief original scientific report: a new surgical approach for the treatment of left pulmonary and hepatic hydatid disease.

BACKGROUND: The combination of pulmonary and hepatic hydatid cysts is frequently encountered, and poses a challenge in terms of surgical accessibility. The surgical treatment of the two locations by the same incision (thoracotomy with phrenotomy) has been proposed, but always from the right side. However, applying this technique to the left side seems to be more difficult and unusual. We herein describe a new left-sided technique that was used to treat two patients with pulmonary and hepatic hydatid cysts. METHODS: The first patient was 14-year-old; he had bilateral pulmonary hydatid cysts and one type I cyst of the left lobe of the liver. The second patient was a 10-year-old female who had a hydatid cyst of the upper left lobe with one type III cyst of hepatic segments 2 and 3. RESULTS: Both patients were operated on via a left lateral thoracotomy through the sixth intercostal space. They underwent cystectomy for the left pulmonary hydatid cysts, followed by padding, and then the hepatic cyst was treated by Lagrot's method via a radial phrenotomy. The postoperative course was uneventful in both cases, with postoperative hospital stays of 3 and 5 days, respectively. CONCLUSION: This combined treatment of pulmonary and hepatic hydatid cysts by the left-sided thoracic approach is feasible and provides a good outcome. It should be indicated under the same conditions of accessibility and feasibility applied for the right thoracic side.

[Pleural complications of pulmonary hydatid disease]. / Kyste hydatique du poumon ouvert dans la plèvre.

BACKGROUND: Pulmonary hydatid disease encountered in Tunisia frequentely. Rupture of pulmonary cyst into the pleural cavity is rare, but represents the most serious complication of the hydatid disease. AIM: We analyse clinical, radiologic and outcome of intrapleural rupture of lung hydatic cyst and evaluate our experience in the surgical treatment. METHODS: We report 5 cases of rupture of rupture of pulmonary hydatid cyst into the pleural cavity hospitilazed during 1995 to 2010. RESULTS: Mean age of patients was 22,4 years. Three patients presented with hydropneumothorax, one with spontaneous pneumothorax and one with haemoptysis. The diagnosis was determined peropreratively in the first case and based on radiographic and serology findings in the other cases. Surgical treatment consist on decortication and cystotomy with capitonnage in three cases, pleurectomy one and lobectomy in the other case. Post operative course was unventful in four cases, one patient had bronchopleural fistula, pneumothorax and wound infection (parietal abssess) resolved with local treatment. After surgery, all patients were treated in post operative by 3 months course with Albendazole chemotherapy with a favourable outcome. CONCLUSION: Rupture of a pulmonary cyst into the pleural cavity is rare, but represents the most serious complication of the hydatid disease. The therapeutic progress has improved the prognosis of intrapleural ruptured hydatid cysts.

Hydatid cyst in heart and lung: a rare case with a 5-year follow-up.

This report describes a male in his late 20s who presented with a 2-month history of recurrent haemoptysis and chest pain. A chronic infection, such as tuberculosis, was suspected. He had undergone surgical resection of an intrapericardial hydatid cyst in the past. His blood investigations showed peripheral eosinophilia, and his chest X-ray showed a cystic oval lesion in the left upper zone. A CT pulmonary angiogram revealed filling defects in the bilateral segmental and subsegmental arteries with a cystic lesion in the left upper lobe. Further workup, including bronchoalveolar lavage culture and MRI of the thorax, confirmed the diagnosis of a hydatid cyst of pulmonary echinococcosis. This case illustrates the presentation of multisystemic echinococcosis in a young male with no other risk factors, initially treated with surgical resection and antihelminthic therapy. The disease later recurred, which required prolonged medications, which brought the patient into remission.

The Impact of Pulmonary Hydatid Cyst Rupture on COVID-19 Symptom Severity.

BACKGROUND: Co-infection with other microorganisms such as parasites in patients with COVID-19 can affect the clinical outcome and require prompt diagnosis and appropriate therapy. CASE PRESENTATION: We present a case of an adult male with chest pain, dyspnea, cough, diplopia, and anorexia who was confirmed to have acute COVID-19 pneumonia. 2 weeks prior to admission, a hydatid lung cyst was identified on examination, but the patient refused surgery. Thoracoabdominal computed tomography (CT) revealed a rupture of the lung hydatid cyst and co-infection with COVID-19. The patient has prescribed a treatment protocol for COVID-19 and albendazole. Despite measures taken to manage severe inflammation and decreasing blood oxygen levels, the patient required admission to the intensive care unit (ICU) and intubation. After approximately 3 weeks of hospitalization, the patient was successfully extubated and discharged uneventfully from the hospital. Oral albendazole was prescribed for follow-up treatment. CONCLUSION: Our case highlights the importance of considering hydatid cysts in the differential diagnosis of patients with COVID-19, especially those living in endemic areas.

[Coexistence of pulmonary sarcoma and hydatid cyst]. / Coexistencia de sarcoma pulmonar y quiste hidatídico.

We present the case of a patient who consulted for cough, showing a mass in the lower lobe of the right lung on imaging studies. Bronchoscopy revealed an irregular, whitish endobronchial formation, from which whitish membranes were aspirated. Biopsies were taken from the aspirated material and sent for analysis Based on the cyto and histopathological study, pulmonary hydatid disease coexisting with a sarcoma was diagnosed. In our area, hydatid disease continues to be frequent and its pulmonary location is, together with the hepatic, the two most common forms of presentation. The usual complication is the rupture of the cyst with the eventual seeding and its infection. In this case, the coexistence of hydatid disease with a pulmonary sarcoma was revealed, a fact of which we only know of one report, more than fifty years ago. The publication is motivated by the extremely infrequent nature of this association, highlighting the importance of carrying out histopathological studies even when clinical and imaging suspicion points to hydatid disease.

Se presenta el caso de un paciente que consultó por tos, evidenciándose en los estudios de imagen una masa en el lóbulo inferior del pulmón derecho. En la broncoscopía se observó una formación endobronquial, blanquecina, irregular, de la que se aspiraron membranas blanquecinas; del material aspirado se tomaron biopsias que se enviaron para su análisis. Con el estudio cito e histopatológico se diagnosticó hidatidosis pulmonar coexistente con un sarcoma. En nuestra zona la hidatidosis continúa siendo frecuente y su localización pulmonar es, junto a la hepática, las dos formas de presentación más comunes. La complicación habitual es la rotura del quiste con la eventual siembra y la infección del mismo. En este caso se pone de manifiesto la coexistencia de hidatidosis con un sarcoma pulmonar, hecho del que solo conocemos un informe, reportado hace más de cincuenta años. Motiva la publicación lo extremadamente infrecuente de esta asociación, resaltando la importancia de efectuar estudios histopatológicos aun cuando la sospecha clínica y de las imágenes orienten a la hidatidosis.

Recurrent pulmonary embolism due to echinococcosis secondary to hepatic surgery for hydatid cysts.

We describe the case of a 53-year-old man with recurrent pulmonary embolism due to intra-arterial cysts from Echinococcus. Both the patient's medical history and the computed tomographic (CT) scan abnormalities led to the diagnosis. The CT scan, performed during hospitalization in our ward, showed cystic masses in the left main pulmonary artery and in the descending branch of the right pulmonary artery. Within cystic masses, thin septa were visible, giving a chambered appearance, which was suggestive of a group of daughter cysts. In the past, our patient underwent multiple operations for recurring echinococcal cysts of the liver. After the last intervention, 4 years earlier, his postoperative course was complicated by pulmonary embolism: a CT scan showed a filling defect in the descending branch of the right pulmonary artery, which was caused by the same cystic mass as 4 years later, although smaller. This mass, not properly treated, increased in diameter. Moreover, after 4 years, there has been a new episode of embolism, which involved the left main pulmonary artery. This is the first case in which there are repeated episodes of pulmonary embolism echinococcosis after hepatic surgery for removal of hydatid cysts.

Abdominothoracic fistulas due to complicated echinococcosis.

PURPOSE: Abdominothoracic fistulas are severe complications of hydatid disease. We report here on the results of surgical treatment of hydatid abdominopleural fistulas in 6 patients. MATERIAL AND METHODS: Between 2004 and 2010, 6 patients with abdominothoracic fistulas (ATF) were treated. The patients were 3 men and 3 women (age range: 47-62 years; median age: 57.1 years). The main symptoms were dyspnea, chest pain, cough, purulent sputum, high fever in 4 patients and additionally bilioptysis in 2. Fistulas were left abdominopulmonary in 1, hepatopulmonary in 2 and hepatopleural in 3 patients. RESULTS: Five patients were operated for ATF and 1 patient was treated with tube thoracostomy. In 4 patients, liver dome hydatid cyst abscesses were exposed through a right thoracophrenotomy, a first left thoracophrenotomy was performed in 1 patient followed by a second left lower lobectomy due to a destroyed lobe. Tube thoracostomy and percutaneous transhepatic drainage was applied successfully in Patient #5. All patients were discharged from hospital in good health. Our strategy consisted of adequate evacuation of the intrahepatic cyst with dissection and closure of the fistula via thoracophrenotomy. DISCUSSION: ATF due to hydatid cyst is uncommon. In rare cases ATF may be present at the abdominal, thoracic or diaphragmatic level. Thoracophrenotomy is the best surgical treatment for all three levels.

Bilateral lung and liver hydatid cysts. Case report.

Introduction. Synchronous occurrence of pulmonary and hepatic hydatid cysts is an uncommon manifestation of hydatid disease that is observed in less than 10% of cases. We report a rare case of bilateral lung (with bronchial fistula) and liver cyst, surgically treated after medical therapy. Case report. A 44-year-old housewife reporting fever, anorexia and fatigue that had been present for the previous 20 days received diagnosis of bilateral lung and liver hydatid cyst. Because of the dimensions of right lung cyst and the successive bronchial fistolization, we proceeded to three-stage operation of two thoracotomies and a laparotomy to control the risk of further rupture. After surgery, all post-operatives were uneventful. Complete resolution of the therapy with no evidence of recurrence at 2 years follow-up. Conclusion. We emphasize the need to search for additional hydatids in patients who present with either pulmonary or liver hydatids. The simultaneous treatment of liver and lung should be reserved to patients in good conditions; in all other cases, especially when one cyst is more symptomatic than the others or has more risk of rupture, we prefer to treat single cyst.