تشخیص

A patient with hydatid cyst
and unusual presenting signs

SHIRVANI F. MD MS
KALANTAR MOTAMEDI M. MD
SHEIKHOLESLAM H. MD
RADFAR M. MD

SURGICAL PROCEDURE:

Posterolateral thoracotomy + hydatid cyst evacuation + left lower lobe lobectomy + chest tube insertion  + pleural space washing

It was mentioned that after entrance to plueral space , it was ruptured

Pathologic results

Microscopic:

A- sections show lung tissue with accumulation of fibrinoleukocytic exudate in ,the alveoli and airways , granulation tissue formation and fibrosis .

B – section show hydatid cyst wall with daughter cysts , germination layer and laminated layer.

The patient received antibiotic by improvement , and after hydatid cyst confirmation albendazole was started for her preoperatively. the drug continued and follow up measures was done.

Echinococcus infection is most common in sheep- and cattle-raising areas and is usually acquired during play with dogs or through

consumption of food or water contaminated with dog feces.

adult of Echinococcus granulosis from dog intestine
 

protoscolices from human hydatid cyst  

Occurrence of 60 percent of hydatid cysts in liver, 30 percent in the lungs, 2.5 percent in the kidney, 2.5 percent in the heart and less than 2 percent in bone, spleen, muscle and brain have been reported. Other rare sites are orbit, urinary bladder, chest wall, subcutaneous tissue, parotid, thyroid and retroperitoneal tissues.
 

 Enzyme-linked immunosorbent assay (ELISA) has up to 84 percent sensitivity                                                                             

Weinberg complement fixation(36-93%sensitivity)
Indirect hemaglutination (66-100%sensitivity)

Where is the place of FNA

Fine needle aspiration biopsy (FNAB) was performed in 31 patients with hydatid disease by 15 operators in 41 biopsy events during the period 1983-93. The FNABs were unintentionally done without prior clinical suspicion of hydatid cysts (HCs) in 18 patients and intentionally (with prior clinical suspicion of HC) in 13 patients for pathologic confirmation required for specific therapy.

only 7 of 31 patients were the specimens diagnostic at the initial interpretation. This emphasizes the importance of alerting the pathologist about the possibility of hydatid disease. In 25 of 31 patients (81%) no biopsy reactions occurred.

 Suggestions for diagnostic and therapeutic management of patients with HC and advice to avoid or limit potential complications or spread of disease are given where a planned biopsy is necessary for appropriate and effective therapy.

Therapy for echinococcosis is based on the size, location, and symptomatic complications of the cysts. Surgery is the treatment of choice; however, removal of the main cyst mass may not be 100 percent effective because small "daughter" cysts can be left behind.

Mrs Z.N. 35 yr old farmer labourer from the Kwazulu-Natal province. University of Johannesburg

Echinococcus multilocularis

CEREBRAL ALVEOLAR ECHINOCOCCOSIS. REVIEW OF THE LITERATURE AND REPORT OF A CASE, Nezih OKTAR , Ege University, School of Medicine, Department(s) of Neurosurgery , Pathology (ED) and Parasitology ,IZMIR,TURKEY

Chemotherapy (e.g., albendazole [Albenza] and mebendazole [Vermox]) is effective against tapeworm disease, and its use is indicated for the treatment of patients with inoperable disease or as presurgical and postsurgical treatment to reduce the risk of recurrence.

Ultrasonographic or computed tomographic (CT)­guided fine-needle aspiration of hydatid cyst contents followed by infusion of a killing agent, such as 95 percent ethanol, and reaspiration, known as PAIR therapy (Puncture, Aspiration, Injection, Reaspiration), has been used successfully at some centers but carries a risk of dissemination of infection or anaphylactic reaction caused by cyst puncture and leakage.