Pulmonary Hydatid Cyst

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Pulmonary Hydatid Cyst

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

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