Hospital-based retrospective analysis of 224 surgical cases of lung hydatid cyst from southern Iran.

BACKGROUND: The lungs are considered the second-most frequent location for hydatid cyst in human. The current retrospective hospital-based study aimed to assess the epidemiological data, clinical presentation, and treatment outcomes of lung hydatid cyst in patients who underwent surgery for this disease in Fars province, southern Iran. METHODS: In this retrospective study, hospital records of 224 pulmonary hydatid cyst patients were assessed in two main university-affiliated hospitals in Fars Province, southern Iran. Clinical features of patients, epidemiological data, cyst features, surgical interventions, and treatment outcomes were reviewed and analyzed. RESULTS: A total of 224 hydatid cyst cases of the lung were reviewed. Male patients accounted for the majority of cases (60.4%). The average age of the patients was 31.13 (± 19.6), ranging from 2 to 94 years old. Of the 224 patients, 145 (75.9%) cases had only one single cyst and mostly 110 (53.9%) located in the right lung. Also, 6 (2.9%) cases had cysts in both lungs. The lower lobe of the lungs was the most common location of the hydatid cyst. The average size of lung hydatid cyst was 7.37 cm (SD = 3.86; rang: 2-24) while for the cyst areas was 42.87cm2 (SD = 52.76; range: 2-488). Regarding the surgical method, 86 (38.6%) cases were operated by lung resection surgery while 137 (61.4%) cases had lung preserving one. The chief complaints of the patients were cough (55.4%) and dyspnea (32.6%). Relapse was documented in 25 (11.16%) of cases. CONCLUSIONS: Lung hydatid cyst is a common infection in southern Iran. Lung preserving surgery is the method of choice for the management of hydatid cyst. Relapse, which was not uncommon in our study, is a challenging feature of hydatid cyst management.

An unexpected guest: Pulmonary echinococcosis diagnosed by intraoperative frozen section examination. A case report and literature review.

Echinococcosis is caused by tapeworms belonging to the Echinococcus genus. The most common site of infection is the liver although it may involve almost any organ. Symptoms of pulmonary echinococcosis vary depending on the location and structure of the cyst. While uncomplicated cysts usually appear at imaging as well-defined homogeneous lesions with fluid content and smooth walls of variable thickness, complicated lesions may have a more heterogeneous content with higher density making more difficult the distinction from malignancies or other infections. Hereby we describe the case of a 61-year-old Northern African male admitted to our tertiary center for left upper chest pain who then underwent a chest computed tomography (CT) scan which demonstrated a large hypodense lesion, with smooth and thick walls, in the upper left lobe. The following magnetic resonance confirmed the homogeneous fluid content, and the 18 F- fluorodeoxyglucose-positron emission tomography/CT demonstrated a mild uptake of the walls. According to these findings, the main differential diagnoses at imaging included bronchogenic cyst, synovial sarcoma, and pulmonary hematoma although the patient denied any recent trauma. Given the large size and clinical symptoms he underwent surgery. Intra-operative frozen section, supported by imprint cytology, excluded the presence of malignancy while suggested an echinococcal laminar exocyst. The final pathological examination confirmed the diagnosis of echinococcosis (i.e., Echinococcus Granulosus protoscolex). After surgery he was treated with albendazole and at the six-month follow-up he was in good clinical conditions. Our case highlights the importance of considering rare infections, particularly in individuals from endemic areas. Frozen tissue analyses can be a diagnostic challenge and often require ancillary tools such as imprint cytology and serial sections for more sensitive and accurate diagnosis.

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.

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.

Proteomics investigation of human sera for determination of postoperative indicators of pulmonary cystic echinococcosis.

BACKGROUND: Cystic echinococcosis (CE)/hydatidosis is an important zoonotic parasitic disease caused by the larval stage of Echinococcus granulosus. The disease is a major health problem all over the world. Finding specific and sensitive biomarkers for follow-up of CE in patients after surgery is essential. Using proteomics methods, the present study aimed to evaluate post-surgical treatment by finding probable biomarker/s in the serum of human lungs CE. METHODS: A total of 24 human sera were tested. These sera included eight confirmed lung/s CE patients sera before surgery (BS), eight sera 12 months post-surgery (12MPS) as well as eight control sera from healthy people. Proteomics methods including 2DE and LC-MS/MS were performed on the specimens followed by bioinformatics analysis. Differentially expressed proteins (DEP) were detected and, separately integrated with protein-protein interaction (PPI) data to construct the PPI network. RESULTS: A total of 171 protein spots were detected in three groups including BS, 12MPS, and control groups; of which a total of 106 DEP have been expressed based on fold changes > = 2 and p-value < 0.05. More analysis was performed and a total of 10 protein spots were selected for identification by mass spectrometry showing the following proteins: APOA1, BGN, SPP2, EAF1, ACOXL, MRPL55, MCTP2, SEPTIN1, B4GALNT1, and ZNF843. Based on centrality parameters of the PPI network (degree and betweenness) five Hub-bottlenecks proteins with significant centrality values were found including APOA1, BGN, SPP2, EAF1, and ACOXL. CONCLUSION: This study showed five proteins as hub-bottleneck proteins; of which APOA1 was more prominent. It can be concluded that a change in expression of this protein in patients' sera could be used as an indicator tool for the achievement of lungs CE surgical therapy.

Pitfalls in the surgical treatment of undiagnosed lung lesions and cystic pulmonary hydatidosis.

BACKGROUND: Hydatid cysts can mimic many lung pathologies radiologically, as well as some malignant or benign lung tumors may show hydatid cyst-like radiological features. The aim of our study is to present our clinical experience and recommendations by analyzing the cases that create diagnostic difficulties by presenting a common radiological pattern with a pulmonary hydatid cyst. METHODS: The patients who were operated on with a preliminary diagnosis of hydatid cyst but were diagnosed differently, and who were operated on with different prediagnoses and unexpectedly diagnosed with hydatid cyst were included in the study. The clinical and radiological features of the patients were documented, and the features of the cases that could cause difficulties in diagnosis and treatment for the surgeon were revealed. RESULTS: A total of 20 patients who were radiologically suggestive of hydatid cyst but were diagnosed differently or unexpectedly diagnosed as hydatid cyst were included in the study. Lung cancer, bronchogenic cyst, or bronchiectasis were detected in 13 patients who were radiologically suggestive of hydatid cyst. There were 7 patients who were diagnosed with hydatid cysts, although they did not have specific radiological findings. CONCLUSIONS: While hydatid cysts can mimic many lung pathologies, many benign or malign parenchymal lung pathologies may exhibit hydatid cyst-like radiological features. Therefore, in regions where a hydatid cyst is endemic, the surgeon should consider all possibilities while managing the cases. CLINICAL REGISTRATION NUMBER: Institutional Review Board of the Dr Suat Seren Chest Diseases and Chest Surgery Education and Research Center (No. 49109414-604.02).

Management of Pulmonary Hydatidosis and Lung Abscess in Low-Resource Settings.

In the modern era, infections of the lung are typically managed medically. However, all pulmonary hydatid cysts require surgery with rare exceptions, and bacterial abscesses require surgery if they are complicated, resistant to treatment, and/or large. Surgical treatment of these pulmonary conditions requires clinical knowledge of tests for causative organisms, perioperative antimicrobial therapies, options for surgical management, and postoperative care.

Clinical and epidemiological characteristics of cystic echinococcosis in children from a tertiary center in Peru. / Características clínicas y epidemiológicas de equinococosis quística en niños de un centro terciario en Perú.

Cystic echinococcosis (CE) in children is a public health problem. To describe the clinical and epidemiological profile of CE, we reviewed the records of 55 children admitted to our institution with a confirmed diagnosis of CE between 2017-2019, analyzing demographic data, clinical manifestations, and treatment. Of the population, 61.8% (34/55) were male. The mean age was 9.25 years (SD: 2.79); 16.4% had previous CE diagnosis, and 50.9% had contact with dogs. The median time of illness was 2 months. Of the patients, 65.5% had hepatic involvement, 56.4% had pulmonary involvement, and 21.8% had both hepatic and pulmonary involvement. The most frequent symptoms were abdominal pain (80.6%) and cough (80.6%). Surgical treatment was performed in 87.5% of patients with hepatic CE, in 100% of those with pulmonary CE and in 100% of those with hepatic and pulmonary CE. Albendazole was prescribed in 100% of hepatic cases, in 73.7% of pulmonary cases, and in 75% of those with both conditions. Mortality was not reported.

La equinococosis quística (EQ) en niños es un problema de salud pública. Para describir las características clínicas y epidemiológicas de la EQ se revisaron los registros de 55 niños con diagnóstico confirmado de EQ admitidos entre 2017 y 2019 en un centro quirúrgico referencial del Perú. Se analizaron los datos demográficos, las manifestaciones clínicas y el tratamiento. El 61,8% (34/55) de los niños fue de sexo masculino. La edad promedio fue de 9,25 años (DE: 2,79); un 16,4% tuvo diagnóstico previo de EQ, y un 50,9% tuvo contacto con perros. La mediana de tiempo de enfermedad fue de dos meses. El 65,5% tuvo afectación hepática, el 56,4% pulmonar y el 21,8% hepática y pulmonar. Los síntomas más frecuentes fueron dolor abdominal (80,6%) y tos (80,6%). El tratamiento quirúrgico se realizó en el 87,5% de los casos con EQ hepática y en el 100% de los casos con EQ pulmonar y EQ hepática y pulmonar. Se prescribió albendazol en el 100% de casos hepáticos, en el 73,7% de casos pulmonares y en el 75% de ambas afectaciones. No se reporta mortalidad.

Hidatidosis pulmonar: comparación de los resultados de la cirugía con y sin capitonaje mediante Propensity Score Matching / Pulmonary hydatidosis: comparison results of surgery with capitonnage versus surgery without capitonnage using Propensity Score Matching

Resumen Introducción: El tratamiento de elección del Quiste Hidatídico Pulmonar (QHP) es la resección quirúrgica. Actualmente, existe controversia sobre la superioridad de la cirugía con capitonaje (CC) versus la cirugía sin capitonaje (SC). Objetivo: Comparar los resultados de la cirugía conservadora CC y SC mediante Propensity Score Matching (PSM). Materiales y Método: Se realizó un estudio analítico retrospectivo de los pacientes con QHP tratados quirúrgicamente en el Hospital Guillermo Grant Benavente, Concepción, Chile; entre enero-1995 y diciembre-2018. Se realizó un PSM con una relación 1:1 entre los pacientes operados con la técnica CC y SC. Posterior al PSM se balancearon las características basales. Resultados: Total 205 episodios de QHP en el período. Se realizó cirugía conservadora en 165 casos, 101 CC y 64 SC. Posterior al emparejamiento se obtuvieron 53 pacientes operados CC y 53 SC. No se observaron diferencias significativas en la presencia de fuga aérea persistente (CC = 9,4%; SC = 11,3%, p 0,75), empiema (CC = 3,8%; SC = 0%, p 0,49), días con pleurotomía (CC = 9,1 ± 8,9; SC 10,1 ± 10,7, p 0,39, mediana 6 versus 6 días, respectivamente), ni días de estadía posoperatoria (CC = 10,4 ± 9,0; SC = 11,7 ± 11,9, p 0,22, mediana 7 versus 7 días, respectivamente). Conclusiones: La cirugía SC demostró resultados comparables a la técnica CC en el tratamiento quirúrgico conservador del QHP.

Background: The treatment of choice for Pulmonary Hydatid Cys (PHC) is surgical resection. There is currently controversy about the superiority of surgery with capitonage (SC) versus surgery without it (SWC). Aim: To compare the results of conservative surgery with capitonnage and versus surgery without capitonnage using Propensity Score Matching (PSM). Materials and Method: A retrospective analytical study was carried out with patients with PHC treated surgically at the Guillermo Grant Benavente Hospital, Concepción, Chile, between January-1995 and December-2018. A PSM was performed with a 1:1 ratio. Results: Conservative surgery was done in 165 cases, 101 SC and 64 SWC. After matching, 53 SC and 53 SWC operated patients were obtained. No significant differences were observed in the presence of persistent air leak (9.4% vs11.3%, SC vs SWC respectively, p 0.75), empyema (3.8% vs 0%, p 0.49), days with pleurotomy (9.1 ± 8.9 vs 10.1 ± 10.7, p 0.39), nor days of postoperative stay (10.4 ± 9.0 vs 11.7 ± 11.9, p 0.22). Conclusión: The SWC demonstrated comparable results to the SC technique in the conservative surgical treatment of PHC.

Pulmonary Echinococcus in children: A descriptive study in a LMIC.

BACKGROUND: Echinococcus granulosus is a major public health problem in lower middle-income countries (LMIC). Children are commonly diagnosed with cysts in the lungs and/or the liver. OBJECTIVES: The purpose of this study was to describe a pediatric cohort diagnosed with pulmonary Cystic Echinococcus (CE) and treated with a combination of medical and surgical therapy. METHODS: This was a retrospective study performed between July 2017 and December 2020 at Tygerberg Hospital, South Africa. Clinical, laboratory, radiological, medical, and surgery-related outcomes were reviewed. RESULTS: The cohort consisted of 35 children, 17 (49%) were male, with a mean age of 9 ± 5.4 years. The most frequently encountered presenting symptom was cough (93%) followed by fever (70%). Isolated pulmonary CE accounted for the majority of cases (74%) with left lower lobe predominance. A significant proportion of the cohort exhibited chest computed tomography (CT) characteristics consistent with complicated pulmonary CE. Eighteen (58%) children had a positive indirect hemagglutination assay (IHA) test result. All children received medical treatment whilst 30 (86%) of children required surgery. Children with complicated pulmonary CE stayed a mean of 12.5 ± 6.6 days, while those with simple cysts stayed 6.8 ± 1.5 days. CONCLUSION: Isolated pulmonary CE is common in children, whereas extrapulmonary cysts are uncommon. Pulmonary CE is diagnosed using chest X-ray and, CT imaging. IHA serology has limited diagnostic utility for pulmonary CE. Combined surgery and chemotherapy remains the gold standard for treating pulmonary CE.

Evaluation of albendazole efficiency and complications in patients with pulmonary hydatid cyst.

OBJECTIVES: This study investigated the efficacy and complications of albendazole use after surgery in patients with pulmonary hydatid cysts. METHODS: One hundred fifty-three consecutive patients who met the study criteria out of 215 patients who received prophylaxis with albendazole after surgery for isolated pulmonary hydatid cysts in our clinic between January 2011 and December 2020 were analysed retrospectively. RESULTS: Eighty-six out of 153 (56.2%) of cases were male and 67 (43.8%) were female. The average age was 24.6 ± 17.4 (between 3 and 71 years), 76 of them (49.7%) were 18 years old and younger, while 77 (50.3%) were adults. All cases were approached transthoracically and a total of 170 operations were performed on the 153 cases. Fever, weakness and dizziness were reported in only one patient who was given albendazole treatment. A partial increase in liver enzymes was observed in 16 cases (10.5%) after albendazole treatment. Mild leukopoenia and neutropenia were observed in only one of the cases. In 1 case, a second operation was performed 30 months later due to recurrence. Albendazole treatment was not required to be discontinued in any of the cases. Mortality was not observed in any of the cases. Factors such as mean age, cyst size and hospitalization period did not have a statistically significant effect on any changes in liver enzymes tests following albendazole therapy (P > 0.05). CONCLUSIONS: Albendazole treatment can safely be used for postoperative prophylaxis in patients with pulmonary hydatid cysts in a controlled manner without causing serious complications. SUBJ COLLECTION: 152.

Fibrin Glue and Partial Capitonnage in Giant Hydatid Cyst in a Pediatric Patient.

Surgical procedure is still used as the first choice in the treatment of pulmonary hydatid cysts. Video-assisted thoracoscopic surgery has started to be performed as a minimally invasive surgical option in recent years for lung hydatid cyst; however, few cases have been reported in the literature, especially in children. Thoracoscopic surgery experience is limited in pulmonary hydatid cyst for both adults and children. We present a pediatric case of giant lung hydatid cyst, in which we performed partial capitonnage with video-assisted thoracoscopic surgery and fibrin glue.