Pulmonary Hydatid Cyst
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Transcript of Pulmonary Hydatid Cyst
PULMONARY HYDATID CYST
PROF.N.NAGARAJAN MCHDEPT OF CARDIOTHORACIC SURGERY
STANLEY MEDICAL COLLEGECHENNAI
CASE REPORT• 60 YEAR OLD FEMALE• C/O DRY COUGH, DYSPNOEA, NONSPECIFIC CHEST PAIN OF
RECENT ONSET• NO H/O PT /HAEMOPTYSIS/ FEVER• O/E PT AFEBRILE, NOT ANAEMIC, NOT DYSPNOEIC, NO CYANOSIS/CLUBBING PULSE/BP/SPO2 --- NORMAL CVS/RS ---- NO CLINICAL FINDINGS ABD ---- NO ORGANOMEGALY
INVESTIGATIONS
• X-RAY CHEST PA --- CYST LOWER LOBE RT LUNG• CT SCAN CHEST --- LARGE SMOOTH CYST
(WITH THICKENING OF WALL) ABUTTING THE HILUM
• USG ABDOMEN --- NO HEPATIC or SPLENIC or VISCERAL HYDATID CYSTS
DIFFERENTIAL DIAGNOSIS• CONGENITAL: BRONCHOGENIC CYST PULMONARY SEQUESTRATION CYSTIC ADENOMATOID MALFORMATION• INFECTIOUS: PULMONARY TUBERCULOSIS COCCIODOMYCOSIS PNEUMOCYSTIS CARINII ECHINOCOCCOSIS• LAM (LYMPHANGIOLEIOMYOMATOSIS)
•
HYDATID MEMBRANES
PULMONARY ASPERGILLOMA
LUNG ABSCESS
HISTORY
• 1687 – BARTHOLIN DESCRIBED CYSTIC LUNG• 1925 – KOONTZ POSTMORTEM COLLECTION
OF CONGENITAL CYSTS
HYDATIDOSIS
• Echinococcosis is a human disease caused by the larval form of Taenia echinococcus
Definitive hosts --- DOGS (canides)Intermediate hosts --- Domestic and wild
animals ( Humans – Accidental)E granulosus causes cystic echinococcosis
worldwideE multilocularis causes alveolar echinococcosis in
Arctic regions
CLINICAL FEATURES
• INCIDENCE Rural > Urban Male:Female ----- 5:1 Lower lobes R>L• Solitary small simple peripheral cyst ---
asymptomatic• Symptoms: chest pain, cough, haemoptysis,
dyspnoea, fever, salty sputum, allergy, sudden collapse (in complicated cysts)
POMEGRANATE SHAPED CYST
WATER LILY APPEARANCE (RUPTURED CYST)CAMALOTE SIGN
INVERSE CRESCENT SIGN (MEMBRANE SEPARATION)
THICKENED WALL (INFECTION)
SIGNET RING SIGN (IMPENDING RUPTURE)
HUGE CYST LT HEMITHORAX
Types
• Type I ---- Single cyst• Type II --- Mature cyst with daughter cysts• Type III – Inert mummified and calcified cyst• Simple/ complicated ( Rupture, Infection)
Complications• Compression --- Restrictive and Obstructiive
changes - Rarely chronic PHT• Rupture -- allergic symptoms and anaphylaxis
-severe hypotension and death• Rupture - transbronchial spread to other
lobes/ pleural hydatidosis/ pleural effusion/ systemic hydatidosis
• Infection -- abscess formation and septicemia• Calcification - rare
MANAGEMENT
• Small cyst< 2-3 cm-----Medical treatment –Albendazole- 3-4 weeks
• Larger cysts>4-6 cm---- Surgical resection• IF THE HYDATID CYST OCCUPIES MORE THAN
50% OF A LOBE ----- LOBECTOMY• Aspiration/ Hypertonic saline injection---carry
the high risk of anaphylaxis