Cystic echinococcosis is endemic in certain parts of the world The growth of the cyst is often slow, and the liver and lungs are the most frequently involved organs Diagnosis is based on clinical signs and symptoms and epidemiological data, while ultrasonography is important for the classification of hydatid cysts Although certain types of hydatid cysts are successfully treated by percutaneous aspiration, injection, and reaspiration, surgery remains the treatment of choice We reviewed the current trends in the diagnosis and management of cystic echinococcosis, with special emphasis on hepatic and pulmonary involvement

Cystic hydatid disease: current trends in diagnosis and management.

Pleural complications of hydatid disease.

Objective: Human echinococcosis remains a serious health problem for the Mediterranean countries, among them Greece. As there is no effective medical therapy, surgery is still the treatment of choice. Material and methods: We present our experience in the surgical management of hydatidosis by a transthoracic approach, based on 85 patients (49 male, 36 female, aged 4‐86 years) treated during 1986‐ 1996. Results: Twenty-one patients (26.3%) appeared with complications as: hydatidemesis (n = 5), hydropneumothorax (n = 3), cyst infection (n = 3), empyema thoracis (n = 8), cholebronchial (n = 3) and cholebronchopleural fistula (n = 1). The location of the cysts was: 61 in the lungs (right, 29; left, 24; bilateral, eight), 31 on the liver dome, six in the pleural cavity, two in the mediastinum, and one in each of pericardium, chest wall, and right pararenal space. Surgical approach involved a thoracotomy or median sternotomy in all cases. Pulmonary endocystectomy and capitonnage was the procedure of choice in the surgical management. Hepatic cysts were approached through a right thoracophrenotomy and were managed with evacuation of the main and daughter cysts, suture of the diaphragm to the margins of the cyst, and drainage of the cystic and pleural cavities. There was no in-hospital mortality. Major postoperative complications were: empyema thoracis (n = 3), biliary fistula (n = 2), and bronchopleural fistula (n = 1). Five patients presented later with seven recurrences of the disease. Conclusion: Transthoracic approach is a good and safe choice in surgical treatment of both the intrathoracic and the (concomitant or not) hydatid cysts on the upper surface of the liver. © 1998 Elsevier Science B.V. All rights reserved

Surgical treatment of echinococcosis by a transthoracic approach: a review of 85 cases

Evaluation of pulmonary hydatid cyst cases.

Objectives: To compare the clinical features and the surgical approaches between single pulmonary (SPH) and hepatopulmonary hydatidosis (HPH). Methods: The hospital and follow-up records of 141 patients who had undergone surgery for pulmonary hydatidosis in our clinic between January 1991 and January 2001 were reviewed. Forty-nine patients (34.8%) had concomitant liver cysts in addition to the pulmonary cysts and they were regarded as HPH (Group I). The remaining 92 (65.2%) patients had SPH (Group II). Both groups were compared according to their clinical, radiological and surgical features. Results: Seventeen (34.7%) male and 32 (65.3%) female patients had HPH. The mean age of the patients with HPH was significantly higher than the age of those with SPH ðP , 0:05Þ and the frequency of hepatopulmonary localization, which is contrary to single pulmonary cyst, was significantly higher in females ðP , 0:05Þ. The majority (67.3%) of the cysts located in the liver were solitary. Multiple pulmonary cysts were in higher ratio in Group II, compared to Group I (45.7 vs. 22.8%) and bilateral pulmonary cyst ratio was higher in Group II, as well (26.5 vs. 13%) ðP , 0:05Þ. In 14 patients (28.6%), the concomitant cysts localized in the dome of liver were extirpated via right thoracophrenotomy, and in one of them sternophrenotomy was performed. There was no statistically significant difference associated with the postoperative complications and hospital stay between groups. No recurrence and mortality were recorded in Group II. Conclusions: Multi-organ localizations (especially liver) should be examined in all patients with pulmonary hydatid cysts. HPH is more frequent in female patients over 40 years of age. The pulmonary cysts in HPH show a tendency to be bilateral and multiple. HPH should be regarded as a different entity since it can cause either economic or labour loss due to the multi-operations and prolonged postoperative care. The operative strategy and approach should be different in hepatopulmonary cysts especially if they locate in the right or bilateral lung. One-session operation with the improvements of its techniques and methods should be considered in selected cases. q 2002 Elsevier Science B.V. All rights reserved.

/pdf/comparison-between-pulmonary-and-hepatopulmonary-hydatidosis-wms5kt69c4.pdf

Comparison between pulmonary and hepatopulmonary hydatidosis.

A series of 460 surgically treated cases of hydatid cyst of the lung is presented. Radiologic preoperative diagnosis was made in 90% of the patients. Cystotomy with subsequent capitonnage was performed in 395 cases, wedge resection in 27, lobectomy in 15 and segmental resection in 23 cases. After careful hemostasis, two drains were placed in the thorax and the thoracic cavity was closed. There were three postoperative deaths (0.6%) and two recurrences of cyst (0.4%) during follow-up investigation for periods up to 10 years.

Surgery in hydatid cyst of the lung. A report of 460 cases.

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Surgery in hydatid cyst of the lung. A report of 460 cases.