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.

The spectrum of imaging findings in pulmonary hydatid disease and the additive value of T2-weighted magnetic resonance imaging in its diagnosis.

PURPOSE: To describe the spectrum of imaging findings in pulmonary echinococcosis and to study the additive value of T2-weighted magnetic resonance imaging (MRI) in the characterisation of pulmonary hydatid disease. MATERIAL AND METHODS: This was a descriptive, prospective study conducted for a period of 3 years from December 2016 to November 2019. Patients suspected of having pulmonary echinococcosis (n = 110) on preliminary chest radiography were examined with chest computed tomography (CT). Among them 41 cases were additionally examined with T2-weighted MRI of thorax. Final diagnosis was based on surgery or histopathology. RESULTS: Of the 110 patients enrolled for the study 15 were lost to attrition, and among the final cohort of 95 patients CT correctly diagnosed 68/84 (80.9%) as hydatid cyst, whereas 16/84 (19.1%) received an erroneous alternate diagnosis on CT. Based on the classical findings of hyperintense pulmonary cystic lesion with T2-weighted hypointense rim or detached internal T2-weighted hypointense membrane, a correct diagnosis of hydatid cyst was possible in 30 patients whereas a correct alternate diagnosis was made in 8 cases. T2-weighted MRI was found to have sensitivity of 96.7%, specificity of 80%, positive predictive value (PPV) of 93.7% and negative predictive value (NPV) of 88.9% with an overall diagnostic accuracy of 92.6%. Using the McNemar test, MRI was found to be diagnostically superior to CT (p = 0.019). CONCLUSIONS: Most of the pulmonary hydatid cysts can be diagnosed on CT; however, sometimes the findings may be indeterminate or atypical, leading to a diagnostic dilemma. MRI, owing to its ability to demonstrate hypointense endocyst, can act as a useful adjunct to correctly diagnose hydatid cyst or suggest an alternative diagnosis.

Rare Case of Giant Pulmonary Hydatid Cyst in a Female Patient Living in Taiz Governorate.

Pulmonary hydatid cyst is a common disorder in many areas of the world. In Yemen, echinococcosis is an endemic disease, however, hydatid disease of the lung is uncommon and usually caused by Echinococcus granulosus. We present a case of a 23-year old female who complained of shortness of breath, dry cough and left-sided dull aching pain for the past few weeks. Chest X-ray revealed a large, well-demarcated mass involving the left mid and lower lung zones with mediastinal shift to the right. Computed tomographic scan revealed a giant, low attenuation fluid density mass with enhancing wall. The diagnosis of giant hydatid cyst was confirmed by surgery and histopathological examination. Pulmonary hydatid cyst can assume a very large size without causing any symptoms and can be discovered incidentally while performing chest X-ray for another reason.

Complete removal of a ruptured pulmonary hydatid cyst during conscious sedation bronchoscopy: A case report and literature review.

The complete removal of a pulmonary hydatid cyst by bronchoscopy occurs rarely in clinical practice. We describe a 22-year-old male originally from Lebanon, with suspected hydatid cyst rupture on computed tomography chest after experiencing sudden onset fevers and cough whilst taking empiric anthelmintic therapy. Bronchoscopy revealed white gelatinous material in the posterior segment of the left lower lobe. The complete membranes of a hydatid cyst were removed with grasping forceps. Histologic examination confirmed the diagnosis of echinococcosis.

Predictive Factors of Pulmonary Hydatid Complications in Children.

BACKGROUND: Pulmonary echinococcosis in children has frequent and severe complications. The aim of our study was to determine predictive factors of pre and postoperative complications of pediatric pulmonary hydatid cyst. METHODS: We conducted a retrospective descriptive and analytic study conducted from January 2010 to December 2018. The study population was divided into two groups to determine predictive factors of pre- and post-operative complications of pediatric pulmonary echinococcosis. Data were analyzed by IBM SPSS 21.0. A p-value of 0.05 was accepted as significant. RESULTS: The study included 106 boys and 94 girls with a median age of 8 years. One hundred and thirty-eight patients (69%) had complicated pulmonary hydatid cyst preoperatively. Univariate analysis identified 12 predictive factors of pre-operative complications: rural origin (p = 0.0001), hydatid contact (p < 0.001), long period between the onset of symptoms and the first medical consultation (p = 0.0001), the autumn and the winter (cold seasons) (p = 0.0001), chest pain (p = 0.0001), hemoptysis (p = 0.023), fever (p = 0.0001), right side (p = 0.01), apical and para hilar location (p = 0.01), superior lobe (p = 0.05), superior right lobe (p = 0.0001), cyst size>5 cm (p = 0.02), positive hydatid serology (p < 0.0001). It identified 2 predictive factors of post-operative complications: giant cyst (p = 0.009) and not performing a capitonnage (p = 0.016). Multivariate analysis showed 4 independent pre-operative predictive factors of complications: rural area (p < 0.0001), fever (p = 0.006), right side (p = 0.02) and positive hydatid serology (p < 0.001). It identified 2 postoperative independent predictive factors of complications: not performing. capitonnage (p = 0.029) and solitary hydatid pulmonary cyst (p = 0.02). CONCLUSION: Pulmonary hydatid cyst management in children needs a thorough appreciation of independent predictive factors of pre and postoperative complications in order to reduce their morbidity.

Mediastinal Mature Cystic Teratoma With Intrapulmonary Extension Mimicking a Hydatid Cyst: Advantages of MRI in Diagnostics.

We report the case of a 37-year-old male patient, who presented with a chief complaint of a sudden throbbing pain in the left side of the chest. Imaging techniques revealed a cystic mass in the anterior mediastinum and the left upper lung lobe. Despite a high suspicion of a hydatid cyst due to the clinical history of the patient and the cystic nature of the lesion, CT and subsequent MRI confirmed the presence of a cystic teratoma, entailing surgical intervention for removal. If untreated, a teratoma can cause significant and life-threatening complications.

Primary Pulmonary Echinococcosis in the United States: A Case Report and Review of the Literature.

We depict a unique case of a 34-year-old woman who presents to the emergency department with complaints of dyspnea and chest pain for the past month. A chest x-ray (CXR) from an earlier urgent care visit was concerning for large fluid opacity in the left lung and follow-up imaging revealed a cystic mass suspicious of a pulmonary cystic abscess. The patient underwent complete lobectomy and resection. Post-surgical biopsy confirmed pulmonary hydatid cystic mass and signs of rupture or seeding to liver tissue. The patient was discharged with adjuvant therapy and recommended imaging follow-up for the next decade. The diagnosis, treatment, and maintenance guidelines are discussed in this report which reveals controversy between experts given the lack of complete literature regarding echinococcosis. Our purpose in putting forward this case is to present a rare diagnosis of pulmonary echinococcosis in the United States and to emphasize the importance of early imaging and diagnosis to prevent cystic rupture and secondary organ dissemination.

Acute respiratory distress syndrome after spontaneous rupture of a large pulmonary hydatid cyst in a 17-year-old male: A case report.

Pulmonary hydatid cysts (PHC) and their complications are still a health concern in endemic countries. Here we described a 17-year-old male presented with a large PHC with a spontaneous rupture. He developed acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. He was treated with albendazole, broad-spectrum antibiotics, and corticosteroids. The patient's general condition did not allow any attempt for surgical resection of the cyst. He was discharged in stable condition after one month and referred to a thoracic surgeon for resection of the cyst. As far as we know ARDS after hydatid cyst rupture was rarely reported, and through this case report we aimed to raise awareness of this possible life-threatening complication.

Large right ventricular hydatid cyst in a child: a case report.

BACKGROUND: Cystic Hydatid disease is a parasitic infection with a worldwide distribution. It is caused by the larval stages of a species of tapeworms known as Echinococcus granulosus. Even in endemic areas; Cardiac involvement by hydatidiosis is very rare and has atypical presentations as well as localization which make it undiagnosed in about 10% of cases. The left ventricle is the most Common chamber involved by the hydatid cyst and isolated involvement of the right ventricle is very rare, especially in children. The aim of the present study was to describe hydatid cardiac cyst of the right ventricle of a child. CASE PRESENTATION: We present a rare case of an 8 year-old boy, living in a rural area, who was diagnosed with a cardiac hydatid cyst in the right ventricle. He also had multiple pulmonary hydatid cysts and presented with dyspnea, cough and atypical chest pain. The patient underwent surgery for the resection of pulmonary cysts and, subsequently, cardiac hydatid cyst. The outcome was favorable seven weeks after surgery and there was no clinical and echocardiographic recurrence. CONCLUSION: Cardiac Echinococcosis must be suspected in endemic areas, diagnosed with appropriate imaging techniques, and treated appropriately.

Hydropneumothorax caused by complete rupture of a pulmonary hydatid cyst: A rare case report.

Hydatid disease is a zoonotic disease endemic in developing regions. It is usually caused by infection with the tapeworm Echinococcus granulosus due to contaminated food or drinks or by close contact with dogs. The lungs are the second most affected organ (25%) after the liver (>65%). Cyst rupture is the most frequent complication. Enlarging pulmonary cysts are more vulnerable to rupture, with rupturing in the bronchial tree being the most common (20%-40%). Hydropneumothorax is a consequence of complete cyst rupture into the pleural cavity and occurs in rare cases (2%-4%). Superinfection is a common complication of the ruptured cyst, which might lead to empyema. A 26-year-old male presented to our clinic with dyspnea that had progressed recently and made him unable to walk a few meters. He had a history of cough and exertional dyspnea and was examined by three different clinics without performing a chest X-Ray. Physical examination revealed fever and a sick appearance. Chest X-ray revealed complete pneumothorax with an air-fluid level in the left hemithorax. Computerized tomography demonstrated two cysts, and one of them was ruptured, causing hydropneumothorax and empyema. The patient was treated with surgery, and follow-up showed recovery with a fully re-expanded lung. Rupture of pulmonary hydatid cyst is seen in the most of cases, the clinicians must be aware of such presentation and management of the pulmonary hydatid disease.

Management of Hydatid Cysts in Pregnancy: A Report of Two Cases and a Review of Literature.

Human hydatidosis is a parasitic infection by the larval stages of the Echinococcus (E.) that rarely occurs in pregnancy (1/20, 000-30 000). Canines are the definitive host while humans are the accidental host. They most often affect the liver (60%) and lungs (30%). E. granulosus causes cystic echinococcosis and is the most frequent form. E. multilocularis causes alveolar echinococcosis and is becoming increasingly more common. E. infections often remain asymptomatic for years before the cysts grow large enough to cause symptoms. Hepatic and pulmonary signs and symptoms are the most common clinical manifestations. There is no consensus on their management in pregnancy. We report two pregnancies complicated by hydatid disease of the liver and lung, discuss their problematic management, and review the recent literature.

Evaluation of clinical status, diagnosis, treatment and radiological findings of pulmonary hydatid cyst: 5-years' experience at tertiary lung center.

BACKGROUND: Hydatidosis is one of the most critical worldwide parasitic zoonotic diseases. The lung is the second most common site of hydatidosis. This study aimed to evaluate the clinical status, diagnosis, treatment, and radiological findings of pulmonary hydatid cyst in patients referred to tertiary lung center. METHODS: From April 2014 to July 2019, patients referred to Masih Daneshvari University Medical Center with the impression of alveolar hydatidosis included. Demographic data of 304 patients were collected including clinical symptoms, laboratory studies, radiological findings, location of the lung involvement, and cyst characteristics. Also, surgical procedures, medical treatments, and post-operative complications were recorded. RESULTS: Pulmonary hydatidosis was confirmed for 234 patients. 55% of patients were males with the mean age of 45.1±16.6 years. The most common symptoms were cough (59.8%), dyspnea (31.1%), and hemoptysis (26%). Left lung, right lung, and bilateral involvement were reported in 40.1%, 55.1%, and 4.8% of cases, respectively. Cyst perforation (39.8%) was the most common intra-operative finding. Surgical interventions included thoracotomy, rigid bronchoscopy, cyst aspiration, and enucleation. The liver was the most concomitant organ involved due to pulmonary hydatidosis (16.6%). The most common postoperative complication was atelectasis, with the rate of 35.7%. 52.2% of patients were discharged within 10 days after surgery. No mortality was reported. CONCLUSION: Sometimes atypical findings in different imaging modalities make the hydatid cyst diagnosis challenging. Although lobe involvement more than 50% has the indication for lobectomy, we conserved lobes with about 70% involvement in our institution, and patients had no postoperative complications.

Diagnosis of a Ruptured Pulmonary Hydatid Cyst in a 26-Week Pregnant Female With Bedside Lung Ultrasound in Emergency (BLUE) Protocol: A Case Report.

Pulmonary hydatid cyst during pregnancy is extremely rare and life-threatening for the mother and fetus. Throughout pregnancy, hydatid cysts may enlarge due to the suppression of cellular immunity and steroids secreted from the placenta. In late pregnancy, the cysts can reach a huge volume with an increased risk for subsequent rupture due to the compression of the enlarging uterus and anaphylactic shock. Intrabronchial rupture is a rare and life-threatening complication of pulmonary hydatid cysts. It is vital to diagnose it as early as possible and manage patients with surgical intervention with aggressive medical treatment. Plain radiograph, computed tomography (CT) scan, and magnetic resonance imaging (MRI) can be used to identify pulmonary hydatid cysts. However, the diagnosis of hydatid cyst is quite challenging in pregnant patients due to concerns of radiation. Herein, we present a 26-week pregnant patient with acute respiratory failure. Bedside lung ultrasound was notable for thickened and severely broken pleural line with a large subpleural consolidation, and a giant fluid-filled cyst covered almost the entire left thorax, causing a mediastinal shift. In the present case, we highlighted that the bedside lung ultrasound in emergency (BLUE) protocol is an easy, safe, and fast way to identify pulmonary hydatid cyst. It should be the initial technique of choice for the diagnosis of pulmonary hydatid cysts in pregnant patients.

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.

An unusual cause of pulmonary hypertension: Mediastinal hydatid cyst.

Hydatid disease is a parasitic zoonosis prevalent in sheep-rearing areas. The lung is the second most commonly involved organ following the liver. Intra-thoracic and extra-pulmonary hydatid disease is rare and can affect the mediastinum, heart, diaphragm, pleura, and chest wall. Uncommon locations represent a diagnostic challenge. We report clinical and imaging manifestations of a compressive mediastinal hydatid cyst revealed by pulmonary hypertension. Radiologists must be familiar with the imaging features of hydatid disease and contemplate the diagnosis when facing atypical chest cystic lesions, especially in patients from endemic regions or with evidence of hydatidosis in a different anatomical location.

Anaphylactic shock due to ruptured pulmonary hydatid cyst in a young patient from Iran.

INTRODUCTION: and importance: Hydatidosis is a zoonotic condition caused by contact with the tapeworm Echinococcus granulosus metacestode. The liver and lungs are the most prominent locations for cysts. This is a rare case of pulmonary hydatid cyst (PHC) rupture in a young woman following a severe cough. CASE PRESENTATION: On July 9, 2018, a 20-year-old woman presented to our hospital in northern Iran with a complaint of cough with excessive sputum, dyspnea, drooling, symptoms of nausea and vomiting, itching and urticarial. Imaging findings showed evidence of a large, space-occupying mass in the right lung. She underwent a thoracoscopic wedge resection (TWR) as a minimally invasive technique, to remove the wall and contents of the cyst. Also, anaphylactic shock occurred in the patient. Due to hemodynamic disorders and heart and respiratory failure, unfortunately, the patient expired. CLINICAL DISCUSSION: The rupture of a hydatid cyst may result in irreversible damage. PHC rupture is a serious complication that causes excessive coughing and chest pain. A rupture into the pleural or pericardial cavity is a serious and potentially fatal disease. CONCLUSION: Anaphylactic shock should be considered as one of the serious complications of PHC, particularly in young ones. Therefore, early diagnosis and appropriate treatment are essential to prevent severe complications such as anaphylactic shock.

A rare combination of cardiac and pulmonary cyst and review of the literature.

Hydatid disease remains an important public health problem in endemic areas. We report a rare case of intramyocardial hydatid cyst of the right atrium along with a pulmonary hydatid cyst in a 16-year-old girl who was admitted to our hospital because of chest pain with recurrent episodes of fainting. One-stage surgery by median sternotomy under cardiopulmonary bypass was performed with excision of the hydatid cyst in the right atrium followed by the removal of the pulmonary hydatid cyst in the same session. Her postoperative recovery was uneventful. Based on this case, we emphasize, the rare combination of cardiac and pulmonary hydatid cyst. Another aspect that makes this case interesting is the location of the hydatid cyst at the right atrium, which is very rare. To the best of our knowledge, our case is the first to describe the combination of a hydatid cyst of the right atrium and the lung.

A Peculiar Case of Hydatid Disease.

Hydatid disease primarily affects the liver which is the most common location. This article highlights a rare representation of the hydatid disease which has led to hematogenous spread of the disease and gives us a wider picture that how a common disease can have an uncommon presentation. Another point that is addressed in this research article is that the widely accepted classification systems for hydatid disease can be modified even further, making them even more accurate. Here, we present a case of a 32-year-old male (non-smoker and non-alcoholic) who presented with focal neurological deficit, diffuse headache, diffuse abdominal pain, and breathing difficulties for the past six months. The patient is a known farmer and lives in an agricultural sheep-grazing area. With the help of MRI brain and non-contrast CT (NCCT) chest and abdomen, it was confirmed to be a case of multiple hepatic hydatid cysts in various stages, with transdiaphragmatic spread to adjacent lung and cerebral hydatidosis as evident by focal neurological deficit. No history of seizures has been given by the patient.

Capitonnage seems better in childhood pulmonary hydatid cyst surgery.

BACKGROUND: Pulmonary hydatid disease remains an important healthcare problem. Conservative operative interventions including cystotomy or cystotomy with capitonnage are the two commonly used techniques. However, there is no scientific consensus over selection of these operative interventions. AIM: The aim of this study is to compare these two methods: capitonnage and uncapitonnage in the surgery of childhood pulmonary hydatid cyst in regard to the postoperative period. METHODS: This is a retrospective analysis of 136 patients operated for pulmonary hydatid disease between January 2010 and July 2017 according to two techniques. Group A was cystotomy with capitonnage (n = 76), and group B was cystotomy alone (n = 60). We compared the postoperative outcomes. RESULTS: Our data showed pneumothorax(PNO) and emphysema were seen in 30% of Group B and only in 13.2% in Group A, and the persistence of residual cavity in 23.3% in Group B and 7.9% in Group A (p = 0.014). We have not seen any case of recurrence with capitonnage. CONCLUSION: We conclude that capitonnage appears to prevent PNO and emphysema formation and a remaining residual cavity in the long term with a significant difference. And it prevents prolonged postoperative air leak and hospitalization with a slightly nonsignificant difference. It is difficult to say with absolute certainty that the noncapitonnage group is inferior to the capitonnage group, since several factors can influence the evolution. TYPE OF STUDY: Clinical research article Level of evidence III.