Tetratrichomonas in pyopneumothorax.

Pleural trichomonosis is clinically rare, and very few cases of trichomonal empyema have been reported so far. A rare case of an 81-year-old woman with pyopeumothorax presenting with recurrent fever and macroscopic pyuria was present. Microscopic examination of the pleural effusion showed mobile flagellated protozoa which molecular methods identified as Tetratrichomonas. In addition, Streptococcus anginosus was discovered in pleural fluid cultures. Treatment with imipenem/cilastatin and metronidazole successfully eliminated the pathogens and led to relief of clinical symptoms. In the context of a review of the relevant literature, the clinical application of molecular methods in the diagnosis of pleural trichomonosis is underlined.

Pneumothorax in pregnancy secondary to ruptured pulmonary hydatid cyst.

Hydatid disease in pregnancy is a rare condition. Ruptured pulmonary hydatid cyst with pneumothorax during pregnancy is potentially serious for both the patient and the fetus. Diagnosis, treatment, and the mode of delivery of the infant all present complex problems related to this event. We describe here a case of pneumothorax occurring during pregnancy secondary to ruptured pulmonary hydatid cyst with a good outcome for both the mother and the fetus.

Molecular diagnosis of sparganosis associated with pneumothorax in a dog.

Pneumothorax was diagnosed in a dog presenting with progressive exercise intolerance and tachypnoea. Needle thoracocentesis failed to resolve the pneumothorax, and an exploratomy thoracotomy was performed. Upon inspection of the thoracic cavity, numerous white nodules (2 to 4mm) were present throughout the mediastinum, parietal pleura and the lung lobes. The owners of the dog elected intra-operative euthanasia, and a post mortem examination was performed. At necropsy, structures consistent with the plerocercoid (larval) stage of a tapeworm were identified in association with inflammation of the pleural cavity. Molecular methods were used to identify the parasite as Spirometra erinacei. Molecular diagnosis, along with the clinical presentation and pathological findings, allowed the diagnosis of proliferative sparganosis.

[Histopathologically diagnosed pulmonary complicated hydatid cyst cases]. / Histopatolojik olarak tani konulan komplike akciger kist hidatik olgulari.

OBJECTIVE: Hydatid cyst disease is caused by the metacestod form of Echinococcosis granulosus from cestods. Pulmonary hydatid cyst is the second most frequent form of the disease after the liver involvement and may open into the bronchial or pleural space by perforation and may cause complications. The aim of the study was to evaluate the clinical features and the frequency of the complicated pulmonary hydatid cyst disease. METHODS: Fifteen hydatid cyst patients were evaluated according to socio-demographical, clinical and radiological findings between 2009 and 2011 retrospectively. Hydatid cyst diseases were diagnosed histopathologically after chest surgery. Diagnostic difficulties and clinical features were analysed in four complicated pulmonary hydatid cyst cases. RESULTS: Pneumothorax, pleural effusion, lung abscess, and hemoptysis were observed in four complicated cases. The complicated cases were diagnosed after surgery. Eleven of lung cysts were intact, radiological and histopathological features were typical for images of hydatid cyst disease and reported as compatible with the clinical diagnosis. A synchronized liver and pulmonary hydatid cyst was evaluated as a morbidity factor. CONCLUSION: Hydatid cyst should be considered in the differential diagnosis of uncertain chest pathologies, especially in rural areas where the disease is endemic.

[Primary heterotopic pleural hydatid cyst presenting as a pneumothorax]. / Un pneumothorax révélateur d'une hydatidose pleurale primitive hétérotopique.

INTRODUCTION: Hydatid cyst is a parasitic disease that is endemic in many countries. Pneumothorax may be a presentation of this disease that presents urgent problems of diagnosis and treatment. CASE REPORT: We report the case of a 23-year-old woman, amenorrheic for 22 weeks, who presented with chest pain and dyspnoea. Chest x-ray revealed a right-sided tension pneumothorax. A check x-ray after drainage showed a homogeneous opacity of water density occupying the lower 2/3 of the right hemithorax. Thoracic ultrasound suggested an uncomplicated hydatid cyst at the right base. Surgical exploration revealed a hydatid cyst 14cm in diameter in the pleural space, and a cavity in the right lower lobe with two bronchial fistulae. Treatment consisted of removal of the cyst intact, closure of the bronchial fistulae and capitonnage of the residual cavity. The postoperative course was uncomplicated. CONCLUSION: Primary heterotopic pleural hydatid cyst is an exceptional cause of pneumothorax that should considered in countries where hydatid disease is endemic. Treatment is surgical following drainage of the pneumothorax.

Ruptured pulmonary hydatid cyst with anaphylactic shock and pneumothorax.

Hydatid cyst is a disease caused by a parasitic tapeworm, Echinococcus granulosus, and most commonly involves liver and lung. Ruptured pulmonary hydatid cyst can present a diagnostic challenge, and radiograph can be inconclusive. Anaphylactic reaction is a rare complication of ruptured pulmonary hydatid cyst. A 22-year-old male came to our emergency department in shock with symptoms of shortness of breath and altered mental status from the previous day. Radiograph showed a thin-walled circular translucent area in the right upper lung field, which was misdiagnosed as pneumothorax, and an intercostal chest tube was inserted. After 5 days, repeat radiograph revealed a cavity with an air/fluid level. The chest tube was removed and contrast-enhanced computed tomogram showed a cavity with water-lily sign, which suggests ruptured hydatid cyst. Immunoglobin-G enzyme-linked immunosorbent assay for Echinococcus was positive. The patient responded well to treatment with crystalloid infusion, supplemental oxygen, and albendazole, and then underwent surgery. Anaphylactic reaction due to rupture of a hydatid cyst is rare, but hydatid disease should be suspected in patients from areas where Echinococcus is endemic.

Large-group infection of boar-hunting dogs with Paragonimus westermani in Miyazaki Prefecture, Japan, with special reference to a case of sudden death due to bilateral pneumothorax.

We recently found a group of 5 boar-hunting dogs infected with Paragonimus westermani. As wild boars are known to be the potential paratenic hosts for this parasite, boar-hunting dogs have obviously a high risk of infection by this parasite. In the present study, therefore, we investigated 20 dogs of another group kept by a hunter in Miyazaki Prefecture, Japan, in order to determine whether paragonimosis is a common problem among boar-hunting dogs. The results showed that P. westermani eggs were present in the feces of 10 out of 20 dogs, while 17 dogs were seropositive on ELISA. Taken together with our previous results, it appears that paragonimosis is a serious problem in boar-hunting dogs. The possible risks of infected dogs acting as a source for maintaining the P. westermani life cycle are also discussed.

[Pneumothorax in distomatosis]. / Pneumothorax au cours d'une distomatose.

INTRODUCTION: Distomatosis is a parasite infection following ingestion of food contaminated by Fasciola hépatica, the tropism of which is essentially hepatic. The mechanism of this exceptional complication is discussed in two cases of pneumothorax. OBSERVATIONS: Two 35 and 60 year-old patients presenting spontaneous pneumothorax during distomatosis, the first revealing the disease, the second suggesting the evolution of a severe form of the disease. The surgical biopsy in the first patient revealed a granulomatous pleuro-pneumopathy rich in giant cells. DISCUSSION: Pulmonary manifestations of distomatosis are frequent during the invasive phase. Their immunoallergic origin can be questioned and emphasis should be placed on lesions secondary to aberrant parasite migrations.

Relapsing pneumothorax due to Ascaris lumbricoides larvae.

We describe a case of relapsing pneumothorax occurring in a male child aged 11 yrs, resulting from the mechanical inflammatory action of Ascaris lumbricoides larvae localized in the pleuropulmonary tissue. Pulmonary ascariasis should still be considered today in the differential diagnosis of spontaneous pneumothorax occurring in children.

Surgical treatment for lung hydatid disease.

Lung is the second most common site for hydatid disease after the liver. The aim of this study is to present the clinical symptomatology, diagnostic evaluation, and surgical techniques for the treatment of lung hydatid disease. During the last 25 years, 42 patients with lung hydatid cysts were treated surgically in our department. In four patients there were cysts in the liver and in one case in the spleen. The cysts were located in the right lung in 16 patients (38%), in the left lung in 23 patients (54.8%), and in both lungs in 3 patients (7.14%). Eighteen patients (42.9%) presented with complications: suppuration in one patient (2.4%), rupture to the bronchial tree in 16 patients (38%), and pneumothorax in one patient (2.4%). Diagnosis was established preoperatively in all cases; chest radiography and computed tomography were most helpful for diagnosis. Forty-six operations were performed in 42 patients; three patients with bilateral cysts underwent staged thoracotomies, and one patient was reoperated for recurrent disease. All cases were managed surgically, with several types of radical (34 cases) or conservative (12 cases) procedures. Radical procedures were lobectomy and rarely pneumonectomy, which were used more often during the first half of the study period. Cystectomy with capitonnage, the most commonly performed conservative procedure, was mainly used during the second half of the study period. Postoperative morbidity was 15.2% and the 30-day mortality rate was 0%. In one case there was postoperative hemorrhage that required reexploration. The median hospital stay for uncomplicated cases was 12 days and for complicated cases 21 days. In conclusion, pulmonary hydatidosis often presents with complications requiring emergency surgery. A lung-conserving operation is the treatment of choice for lung hydatid disease and offers a good surgical outcome with a minimal recurrence rate.

Ectopic ascariasis: an unusual case of pyopneumothorax.

A patient of tuberculous pyopneumothroax with broncho-pleural fistula in whom a mature roundworm Ascaris lumbricoides migrated from the intestine to lodge itself in the pleural cavity is being reported.

Pulmonary paragonimiasis: clinical and experimental studies.

Pulmonary paragonimiasis is a disease caused by a lung fluke. It is endemic to East Asia, but there have been several case reports in North America. Human infestation occurs by ingestion of raw or incompletely cooked freshwater crab or crayfish infected with metacercaria. A retrospective study was performed with 78 patients who lived in South Korea and had chest radiographic findings of pleuropulmonary disease; it was subsequently shown that they had paragonimiasis. The diagnosis was based on positive results of serologic tests for Paragonimus-specific antibody or on the detection of eggs in sputum samples. Radiologic findings from these 78 patients were correlated with the pathologic and radiologic findings from a study of experimentally induced pulmonary paragonimiasis in 21 cats. Findings from the correlative study document that the typical radiologic manifestations of pulmonary paragonimiasis vary with the stage of the disease. Early findings include pneumothorax or hydropneumothorax, focal airspace consolidation, and linear opacities and are caused by the migration of juvenile worms. Later findings include thin-walled cysts, dense masslike consolidation, nodules, or bronchiectasis and are due to worm cysts.

[Localization of Ascaris lumbricoides in the thoracic cavity. Report of a case]. / Localizactón en cavidad torácica de un Ascaris lumbricoides. Presentación de un caso.

Several aspects of the history, evolutive cycle and erratic phases of Ascaris lumbricoides as well as of the symptoms and diagnosis of ascariasis are analyzed. The anatomicophysiological concept of spontaneous pneumothorax and its clinical picture, frequency and treatment are exposed. A patient who underwent thoracic surgery due to an acute respiratory syndrome in who a male Ascaris lumbricoides was surprisingly found obstructing the probe after an explorating left thoracotomy and a resection of the lung apex is presented. The nematode is suggested as the possible etiological agent of the respiratory disease.