Current Management of Pulmonary Hydatid Cyst

Abstract

Hydatid disease is a zoonotic infection caused by the larval stage of the Echinococcus granulosus worm, commonly found in developing countries. The lungs represent the second most commonly affected organ in both children and adults. The disease is more common in children than in adults, and the growth of hydatid cysts is more rapid in children than in adults. Diagnosing uncomplicated cases of hydatid cysts is generally straightforward clinically and radiologically. However, difficulties may arise in diagnosing complicated cysts. Surgery is the definitive treatment for pulmonary hydatid cysts. The surgical approach is contingent upon a number of factors, including the dimensions of the cyst, the integrity of its structure, whether it is solitary or multiple, unilateral or bilateral, and the extent of lung parenchyma destruction. In contrast to the liver, surgical treatment is promptly planned upon the diagnosis of a pulmonary hydatid cyst. The most effective surgical method is cystotomy and capitonnage while maintaining the integrity of the lung parenchyma to the greatest extent possible. Albendazole is the preferred medical treatment, but it is not recommended for intact cysts during the preoperative period due to its potential to weaken the cyst wall and cause rupture. Albendazole is administered to prevent postoperative recurrence and for treatment in cases where surgery is not feasible.

Figure 1.

Coronal section of chest computed tomography (CT) with lung window in a 32-year-old female patient showing an intact hydatid cyst (asterisk).

Figure 2.

Axial section of chest CT in a 68-year-old male patient showing a complicated hydatid cyst in the right middle lobe of the lung as seen in the mediastinal (A) and lung (B) windows (arrow).

Figure 3.

A 12-year-old male patient with a ruptured hydatid cyst in the right upper lobe causing a water-lily sign (arrow).

Figure 4.

A 45-year-old male patient with a hydatid cyst in the right upper lobe showing a crescent sign (arrow) due to air entering between the pericyst and the laminar membrane.

Figure 5.

Posteroanterior chest radiograph (A) and axial chest CT (B) of a 5-year-old male patient with intact cysts measuring approximately 75 mm in the right lower lobe and 65 mm in the left lung (asterisks).

Figure 6.

The modified capitonnage technique (Aydin technique) developed for the surgical treatment of a giant pulmonary hydatid cyst is illustrated. The suture entering the pericystic wall (A) is retrieved from the pleura (B) and the same procedure is applied to the opposite wall of the pericystic cavity (C, D). The sutures within the pericyst are ligated and cut (E, F).