BACKGROUND: Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options. METHODS: A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia. RESULTS: 52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism. CONCLUSION: Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.
BACKGROUND: Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options. METHODS: A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia. RESULTS: 52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism. CONCLUSION: Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.