Pulmonary hydatic disease presenting as solid mass with haemoptysis in a child

Abstract

A middle childhood HIV-negative female patient presented with three episodes of haemoptysis. The chest X-ray demonstrated an oval-shaped, well-circumscribed left upper lobe homogenous opacification. She did not respond to tuberculosis treatment. A left upper lobectomy was performed for a solid mass in the lung, and hydatic disease was histologically confirmed. Calcification was found in the pulmonary lesion. Pulmonary hydatic cyst rarely presents as a solid lesion with calcifications and haemoptysis.

Keywords: Cardiothoracic surgery; Paediatrics; Tuberculosis.

Figure 1

(A) Frontal and (B) lateral plain radiographs of the chest in a middle childhood girl presenting with haemoptysis, demonstrate a left upper zone oval density with well-demarcated borders, but no recognisable internal characteristics. There is no mediastinal or hilar lymphadenopathy and the airways are patent.

Figure 2

CT chest with intravenous contrast in the same patient as figure 1 (A) axial soft-tissue window (B) axial lung window and (C) coronal reconstruction, confirms the left upper lobe oval mass with sharp margins and very little surrounding parenchymal reaction, and displacement of vessels around it. Internal density measures approximately 60–70 HU without any calcification. There are some areas of central lower density but no ring enhancement. No accompanying mediastinal or hilar lymphadenopathy.

Figure 3

Image of the hydatid cyst. (A) A low power magnification showing a cyst that is lined by respiratory epithelium with the hydatid cyst in the lower half of the image with acute inflammation (H&E, 4x). (B) Shows a slightly higher magnification of a, with the blue arrow showing the laminated wall of the organism and the green arrow indicating the respiratory epithelium lining to the cyst (H&E, 10x). (C) Shows the ‘hydatid sand’ debris of the dead contents of the cyst with calcifications (H&E, 40x). (D) An echinococcus hooklet, with a shark-like appearance. These hooklets are made up of chitin and are more resistant to breakdown, hence they remain identifiable in the hydatid sand debris (H&E, 100x).