Hydatid Cysts

1
Pulmonary hydatid cysts A rare cause of
haemoptysis and dyspnoea E Boeykens , A. M.
Vints, E. Bottieau, B. Op De Beeck, E. Van Marck,
P. Van Schil, W. De Backer Department of
Respiratory Medicine, University Hospital of
Antwerp, Antwerp, Belgium.
Since worldwide travel and migration increase
considerably, physicians of industrialised
countries encounter more travel- related health
problems and uncommon infectious diseases.

• Case 1 Female, 47 years .
• Haemoptysis, fever and left-sided thoracic pain.
• Chest X- ray mass in the left lung.
• CTscan large cystic structure, smaller cystic
  lesion inside. No other organs involved.
• MRI no contact with the diaphragm.
• Serological testing for echinococcosis
  negative.
• Tentative diagnosis pulmonary hydatid cyst.
• Treatment albendazole and surgery.
• Histopathological confirmation.

• Case 2 man ,37 years.
• Dyspnoea, pain in the right hypochondrium.
• Chest X-ray cyst in the left upper lobe.
• CTscan cystic structure in left upper lobe and
  in the liver.
• Serology for E.granulosus slightly positive.
• Tentative diagnosis echinoccocal disease.
• Treatment albendazole and surgery( lobectomy of
  the left upper lobe).
• Histopathological confirmed.

• Treatment
• Surgery is preferred, global cure rate 90.
• Pre-surgery medical treatment with albendazole
  recommended, at dose of 10-15 mg/kg per day in
  two gifts.
• (at least four days before surgery and to
  continue for at least one to three months).
• drugs only patients with inoperable disease,
  multiple cysts (2 or more organs), after
  incomplete surgery or relapse, for prevention of
  secondary spread following rupture and where
  surgery facilities are not available.

• Pathogenesis
• infection with tapeworm Echinococcus
• 4 species in humans E
  granulosus causes cystic echinococcosis
  (hydatidosis)
• ingestion of the parasite eggs
• eggs contain embryos (oncospheres) which
  penetrate the intestinal mucosa and enter the
  blood and lymphatic system
• movement to visceral organs
• Development of a fluid-filled cyst (hydatid cyst)
  
• Liver 2/3 of patients, lung 25

• Diagnostic work-up
• laboratory lt15 eosinophilia,
• serology anti-echinococcus antibodies pulmonary
  hydatidosis positive in 50, hepatic cysts in
  90.
• Chest radiography valuable
• Ultrasound screening abdominal cysts, follow-up
  after treatment.
• CT scan site, size and structure of cyst
• MRI no major advantage
• histopathological examination visualisation of
  cyst wall with scolices or remnants( hooklets)
  using Ziehl-Neelsen stain.

References 1. R. Morar, C. Feldman.Pulmonary
echinococcosis. Eur Respir J 2003211069-1077