Bronchoscopic Diagnosis and Complete Treatment of a Ruptured Left Pulmonary Hydatid Cyst

Abstract

INTRODUCTION: Hydatid disease is not an endemic disease in Romania. Hydatid cyst disease is caused by Echinococcosis granulosus from cestods. Pulmonary hydatid cyst is the second most frequent form of the disease after the liver involvement and, rarely, may be atypical and misdiagnosed. CASE PRESENTATION: We present a case of 27 year-old white man, smoker (7.5 package-years), with a four months history of chronic cough, left chest pain and sweats, who was addmited in our hospital for recurrent hemoptysis. Chest film revealed in the upper left lobe an atypical ovalar homogenous, ill-defined nodular lesion, mimicking a tumoral process in the upper lobe. He had history of close contact with dogs in the previous 12 years. Fiberoptic bronchoscopy reevaluation, performed in Marius Nasta Pneumology Institute, confirmed the definitive diagnosis as ruptured pulmonary hydatidosis by revealing a white gelatinous membrane- like structure protruding from the subsegmentary bronchus of apicoposterior segmental bronchi of the left upper lobe, which was totally removed by aspiration. A control thoracic CT-scan was performed and revealed a small residual cavity in the left upper lobe with a bronchial dilatation. Hydatid serology was positive. Abdominal ultrasonography was normal, with no evidence of hydatid cysts in the liver. The young adult did not require thoracic surgery and made a full clinical and stable recovery under therapy with Albendazole. After 2 years, his chest film is normal. DISCUSSION: Humans may contract the disease by ingestion of eggs from contaminated water, food or from close contact with dogs. Pulmonary hydatid cysts are often asymptomatic and can be, incidentally, diagnosed on plain chest radiographs but CT is the preferred imaging exam.[1] Several cases of pulmonary hydatic cyst opened into the bronchial tree by perforation were described, mostly, in endemic areas, such as Turkey.[2] When a hidatid pulmonary cyst ruptures into the bronchus, the radiologic pattern of the disease may mimic several diseases, such as nodular pulmonary tuberculosis, round pneumonia, lung abscess or, even, tumour of the lungs. [3] Few articles have described the impact of bronchoscopic management of parenchymal lung hydatid cysts complicated by endobronchial involvement in children and adults. Treatment of pulmonary hydatid cyst by endoscopy is an exceptional event. CONCLUSIONS: Our case illustrates an atypical clinical and radiological presentation of pulmonary hidatidosis complicated with rupture into bronchus. Flexible bronchoscopy is a valuable diagnostic procedure which may offer, in the same time, a complete and stable curative treatment.