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156-158-narang-Curr Pediatr Res 2012; 16 (2): 156-158 ISSN 0971-9032
Ruptured hydatid cyst of lung.
Mandeep Singh Khurana, Gursharan Singh Narang, Kulwant Singh Ded, Loveleen Kaur
Department of Paediatrics. Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research,
Vallah, Amitsar, India.
A 14yr old boy presented to us with complaints of cough associated with expectoration since
15 days and fever since 10 days. Chest X-ray and CT scan was done which showed ruptured
hydatid cyst in right lung. Rupture, with an incidence of 49%, is the most frequent
complication of pulmonary hydatid cyst.
Keywords: Hydatid cyst., lung, X-ray, CT Scan
effusion with floating membranes and air fluid levels s/o pulmonary hydatid cyst ruptured into the pleural cavity. This is a case of 14yr old male who presented with fever, Child was started on albendazole therapy pre operatively, investigating it was diagnosed as a case of ruptured and then was taken up for surgical removal of cyst. hydatid cyst of lung. Patient was treated with albendazole Thoracotomy was done and cyst was removed and child and surgical resection was done uneventfully. was given full course of albendazole. The chest tube was kept insitu for about 15 days and removed after the lung expanded well. Case report
A 14yr old boy presented to us with complaints of cough Hydatid disease due to Echinococcus granulosusis with expectoration since 15 days, fever since 10 days endemic in cattle-and sheep-raising regions of the world which was high grade associated with chills. Fever was such as Central Europe, the Mediterranean countries, the intermittent, recurrent in nature. There was history of Middle East, South America, Australia, New Zealand, and vomiting since 10 days which was non projectile. Child South Africa.(1-3) The incidence of cystic echinococcosis
also had complaints of difficulty in breathing in form of in endemic areas ranges from 1-220 cases per 100,000 increased rate of breathing and also complaints of pain in echinococcosis ranges from 0.03-1.2 cases per 100,000 On examination child was febrile, respiratory rate was inhabitants, making it a much more rare form of increased. On chest examination bilateral air entry was echinococcosis. Although hydatid cysts are known present but decreased on right lower zone and bronchial commonly to affect the liver and lung, our experience breathing was present in right lower zone. On abdomen with this series shows that it can also affect the brain, examination liver was just palpable 2cm below costal heart, kidney, ureter, spleen, uterus, fallopian tube, margin. Rest systemic examination was normal. On mesentery, pancreas, diaphragm, and muscles. Brain routine investigations child was found to have low involvement, which is more commonly seen in children, haemoglobin, counts were mildly raised and ESR was is encountered in 1-2% of the patients and the cysts are raised to 80mm/hr. Chest X-ray done showed hydropneumothorax with underlying collapse seen in localization.(2) Cardiac involvement with echinococcosis
right hemithorax . Patchy consolidation seen in left lung is uncommon (O.02%-2%); the left ventricular wall is the parenchyma. Next we went for CT-abdomen which most frequent site, but the interventricular septum, right ventricle and left or right atrium may also be involved communicating with the right upper lobe bronchus ruptured into the pleural cavity, resulting in gross pleural complications of cardiac hydatid disease result from 156 Curr Pediatr Res 2012 Volume 16 Issue 2 rupture of the cyst either into the heart or pericardium and death may occur subsequent to anaphylactic shock, cardiac hypertension(.4,5) Contrary to adults, incidence of
involvement is equal in lung and liver (41% and 43%).
Combined lung and liver involvement is more frequent in
children than adults(16% vs. 4%).(6,7) Pancreatic
involvement has been reported in 0.25—0.75% of adult
cases and the mode of infestation is presumed to be
haematogenous, although local spread via the pancreatic
or bile ducts has been suggested, as well as peripancreatic
lymphatic invasion.(3) Pre-operative diagnosis of hydatid
cysts of the pancreas may be difficult, because it may be
confused with pseudopancreatic cyst adenocarcinoma and
true congenital and post-traumatic pancreatic cysts(.8)
The treatment of hydatid cysts is principally surgical.
However, pre- and post-operative 1-month courses of Albendazole and 2 weeks of Praziquantel should be Figure 1. Chest X –ray AP view showing cyst in the right
considered in order to sterilize the cyst, decrease the chance of anaphylaxis, decrease the tension in the cyst wall (thus reducing the risk of spillage during surgery)
and to reduce the recurrence rate post-operatively [1,9].
Intra-operatively, the use of hypertonic saline or 0.5%
silver nitrate solutions before opening the cavities tends to
kill the daughter cysts and therefore prevent further
spread or anaphylactic reaction(9) Even though mortality
directly due to echinococcosis is very low, it can produce
a very disabling morbidity. A mortality rate between 0.29
and 0.6% has been reported . Echinococcus
granulosas can affect any organ in the body and a high
suspicion of this disease is justified in any cystic
neoplasm of any organ, especially in endemic regions
Rupture, with an incidence of 49%, is the most frequent
complication of pulmonary hydatid disease. Communica-
ting rupture occurs when the cyst contents escape via
bronchial radicles which are incorporated in the pericyst.
Rupture of the hydatid cyst into the bronchus occurs due
to the degeneration of the membranes and manifests as
coughing and expectoration of a large amount of salty sputum containing mucus, hydatid fluid, and rarely Figure 2. Chest X ray Rt lateral view showing hydatid
fragments of the laminated membrane. Thereby, solid remnants of the collapsed parasitic membrane are left in References
In pulmonary hydatid disease, the radiological signs are Goel MC, Agarwal MR, Misra A. Percutaneous usually precise contrary to the clinical presentation. The drainage of renal hydatid cyst: early results and follow- appearance of a pulmonary hydatid cyst may change secondary to perforation which necessitates further use of Altinors N, Senveli E, Donmez T, Bavbek M, Kars Z, Sanli M. Management of problematic intracranial CT. Endocyst detachment associated with rupture is seen hydatid cysts. Infection 1995; 23: 28-287. as a floating membrane within the cyst by CT. Brown RA, Millar AIW, Steiner Z, Krige JEJ, Characteristically, the crumpled endocyst membranes Burkimsher D, Cywes S. Hydarid cyst of the pancreas: floating freely on the surface of the remaining cyst fluid a case report in a child. Eur J Pediatr Surg 1995; 5: after the complete collapse results in a convex serpinginous margin at the air-fluid level, an appearance Alehan D, Celiker A, Aydingoz U. Cardiac hydatid known as “water lily sign” or “floating lily sign”. cyst in a child:diagnostic value of echocardiography Curr Pediatr Res 2012 Volume 16 Issue 2 and magnetic resonance imaging. Acta Paediatrica Japonica 1995; 37: 645-6477. Unal M, Tuncer C, Serce K, Bostan M, Erem C, Gokee M. A cardiac giant hydatid cyst of the intervenmeular septum masquerading as isebemic heart disease: role of MR imaging. Acta-Cardiol 1995; 50: 323-326. Schwartz SI. Liver. In Schwartz SI, Shires GT, Spencer FC, Daly JM, Fischer JE, Avbrey CG. Principles of surgery. 7th ed, New York, McGraw-Hill 1999; p. 1403-1405. 18. Little JM. Hydatid disease. In: Morris PJ, Malt RA. Oxford textbook of surgery. 1st ed, New York, Oxford University Press 1994; pp: 2507-2511. Lemmer ER, Krige JE, Price SK, Girdwood All. Hydatid cyst in the head of the pancreas with obstructive jaundice. J Clin Gastroenterol 1995; 20: 136-138. Kune GA, Morris DI. Hydatid disease In: Schwasyz & Ellis, eds. Maingot’s Abdominal Operations, 9th edn. Appleton & Lange, 1989: 1225-1240. 10. Chen WQ. Surgical management of complicated pulmonary hydatidosis. Chung-Hsoa-Wai-Ko-Tsa-Chih 1992; 30: 216-217.
Gursharan Singh Narang
Department of paediatrics
Sri Guru Ramdas Institute of Medical
Sciences and Research
158 Curr Pediatr Res 2012 Volume 16 Issue 2
Your Pills, the Heat and Sun of Summer By Lynn Harrelson, R.Ph., FASCP Senior Pharmacy Solutions Medication Therapy Management Services Everyone is eager for the warmer, sunny months of summer. We can’t wait for the warmth of spring and then, in a blink, we have the hotter, sunnier summer months. Our bodies adjusted better to these changes when we were y