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. Abstract 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 Introduction
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 Discussion
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 [10].Echinococcus granulosascan 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
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Correspondence to: Gursharan Singh Narang Department of paediatrics Sri Guru Ramdas Institute of Medical Sciences and Research Vallah, Amritsar India. 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
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