Primary pulmonary cystic Echinococcus in an immunocompetent patient

Abstract

A 60-year-old man was referred to the interventional pulmonology clinic with a large right-sided intraparenchymal lung mass and a second, smaller lesion in the left lower lobe, accompanied by intermittent haemoptysis, fever, chills, productive cough of white phlegm as well as dizziness and weakness. He had presented previously and was being evaluated for the possibility of malignancy. Investigations had revealed 'hooklets' (protoscolices) of hydatid cysts, most likely representing the parasite Echinococcus Successful surgical excision of the affected lobe, lung decortication, partial pleurectomy and pneumolysis of the adhesions was performed, along with long-term antiparasitic therapy. The initial differential diagnosis for this patient was challenging and required multimodal investigations. The patient made good recovery and continued to be followed by infectious disease specialists for management of antiparasitic therapy.

Keywords: infectious diseases; medical management; respiratory medicine.

Figure 1

Right middle lobe mass noted on coronal CT without contrast.

Figure 2

Right middle lobe mass noted on axial cut of CT without contrast.

Figure 3

Flexible bronchoscopy imaging of cystic mass protruding from the lateral subsegment along with image following forceps biopsy.