Surgery for parasitic lung infestations: roles in diagnosis and treatment

Abstract

Pulmonary parasitic infestations are a worldwide problem associated with significant morbidity and socioeconomic impact. They are known to have varied clinical presentations and radiological appearances. Prevention of parasite transmission and medical treatment of cases form the two pillars of control of these diseases. The role of surgery is limited to the diagnosis and definitive treatment of the minority of pulmonary parasitic afflictions, most notably hydatidosis. Despite surgery being established as the treatment of choice in pulmonary hydatid cysts (PHCs) for over half a century, variations and unresolved controversies persist regarding the best surgical technique. Complications brought on by cyst rupture, multiplicity and multi-organ involvement add complexity to treatment decisions. The development of video-assisted thoracoscopic surgery (VATS) brings the promise of reduced peri-operative morbidity but is yet to be universally accepted as a safe technique. In this review, we endeavor to discuss the common pulmonary infestations focusing on the current trends and controversies surrounding surgery for PHC.

Keywords: Echinococcosis; pulmonary parasitic infestations; surgical management.

Figure 1

Radiological appearances of pulmonary hydatid cysts. (A) X-ray chest showing multiple and bilateral cysts; two in right lung (one intact and one ruptured) and single intact left lung cyst; (B) CT scan of the same patient; (C) CT scan showing a giant hydatid cyst in the left upper lobe; (D) Multi-organ involvement—CT scan demonstrating a lung and liver hydatid cysts. CT, computed tomography.

Figure 2

Enucleation of a pulmonary hydatid cyst. (A) Isolation of the cyst containing lobe with povidone iodine soaked packs; cruciate incision on the pericyst; (B) delivery of the intact cyst by positive pressure ventilation on the ipsilateral lung; (C) intact cyst after delivery; (D) bronchial opening seen after cyst delivery.