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LETTER TO THE EDITOR
Year : 2012  |  Volume : 11  |  Issue : 2  |  Page : 122-123  

Giant pulmonary hydatid cyst mimicking elevated diaphragm: A diagnostic dilemma


Department of Tuberculosis and Chest Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202 002, UP, India

Date of Web Publication6-Mar-2012

Correspondence Address:
Jamal Akhtar
Department of Tuberculosis and Chest Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh 202 002, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.93539

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How to cite this article:
Akhtar J, Khan NA, Baneen U, Shameem M, Ahmed Z, Bhargava R. Giant pulmonary hydatid cyst mimicking elevated diaphragm: A diagnostic dilemma. Ann Afr Med 2012;11:122-3

How to cite this URL:
Akhtar J, Khan NA, Baneen U, Shameem M, Ahmed Z, Bhargava R. Giant pulmonary hydatid cyst mimicking elevated diaphragm: A diagnostic dilemma. Ann Afr Med [serial online] 2012 [cited 2020 Oct 24];11:122-3. Available from: https://www.annalsafrmed.org/text.asp?2012/11/2/122/93539

Dear Sir,

Giant pulmonary hydatid cyst is a rare clinical entity and can be a diagnostic challenge on chest radiograph. Here we are reporting a case of giant pulmonary hydatid cyst which mimicked as elevated diaphragm on chest radiograph. A 45-year-female patient presented to us with complaints of right-sided chest pain, dry cough, and low-grade fever since 2 months. On vitals examination her blood pressure was 110/76 mmHg, pulse rate 100/min, respiratory rate 22/min, and temperature 38°C. There was no cyanosis, clubbing, or lymphadenopathy. On respiratory system examination, breath sound was decreased and percussion note was dull in right infrascapular and inframammary area. In laboratory investigation, total leucocyte count was 9400 cells with 65% neutrophils, 15% lymphocytes, and 17% eosinophils. The absolute eosinophils count was 1100 cells. Herliver function test and renal function test were normal. Sputum for acid fast bacilli was negative. Chest radiograph postero-anterior view was suggestive of right-sided elevated diaphragm [Figure 1]. Ultrasonography of abdomen was normal. Contrast-enhanced computed tomography of thorax revealed a large rounded, well-circumscribed loculated cyst with little remaining lung tissue on right side [Figure 2]. IgG Elisa for ecchinococcous granulosus was positive. Patient was diagnosed as a case of giant pulmonary hydatid cyst. Patient was treated by surgical resection of cyst.
Figure 1: Chest radiograph postero-anterior view suggestive of right sided elevated diaphragm

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Figure 2: Contrast-enhanced computed tomography of thorax shows a large rounded, well-circumscribed loculated cyst with little remaining lung tissue on right side

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Hydatid cyst is a parasitic disease caused by larval stage of ecchinococcus granulossus characterized by cyst formation in liver and lung, rarely in other part of the body. It is endemic in south and Central America, Middle East, sub-Sahara Africa, Russia, China, Australia and New Zealand. Most common organ affected by this disease is liver followed by lung, involvement of other part of the body like spleen, kidney orbit and heart is rare. [1] Pulmonary hydatid cyst are characteristically solitary, usually affecting single lobe, mostly lower lobe, and more commonly the right side. [2]

The plain chest radiograph is very helpful in diagnosis of pulmonary hydatid cyst. Non-complicated hydatid cyst is usually asymptomatic and are identified on routine chest radiograph incidentally. Unruptured pulmonary hydatid cyst shows one or more homogenous round or oval masses with smooth borders surrounded by normal lung tissue on chest radiograph. [3] Water lily sign and crescent sign are pathognomic for ruptured hydatid cyst. Ruptured hydatid can also produce cumbo's sign, serpent sign and monod's sign. [1] Giant pulmonary hydatid cyst in our case mimicked as elevated diaphragm on chest radiograph and causes a diagnostic error on chest radiograph. CT scan can demonstrate the cystic nature of lung lesion and a thin enhancing rim if the cyst is intact. Enzyme-linked immunoabsorbent assay is positive only in less than 50% cases of pulmonary hydatid cyst. Giant pulmonary hydatid cyst is a rare clinical entity and is defined as more than 10 cm in size. [4],[5] Giant pulmonary hydatid cyst and complicated hydatid cyst are usually symptomatic. Common presenting symptoms of giant pulmonary hydatid cyst are compression symptoms such as dry cough, while ruptured cyst can cause productive cough, chest pain, dyspnoea, and very rarely anaphylactic shock. [6] The current treatment of the hydatid of lung is complete excision of the cyst including germinative membrane with maximum preservative of normal lung tissue. [7] Medical treatment (Albendazole 10-15 mg/kg/day for 4 weeks for 2 or more courses with an interval of 2 weeks) can be given in inoperable courses or in case of small cyst. [8]

 
   References Top

1.Morar R, Feldman C. Pulmonary echinococcosis. Eur Respir J 2003;21:1069-77.  Back to cited text no. 1
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2.Shenoy VV, Joshi SR, Aklujkar AP, Kotwal VS, Nadkarni NA, Ramraje NN. Pulmonary Hydatd cyst in HIV-1 Disease. J Assoc Physicians India 2005;53:1070-72.  Back to cited text no. 2
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3.Beggs I. The radiology of hydatid disease. AJR Am J Roentgenol 1985;145:639-48.  Back to cited text no. 3
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4.Rashid S, Fatimi SH. Atypical pulmonary giant hydatid cyst as bilaterally symmetrical solitary cysts. Asian Cardiovasc Thorac Ann 2004;12:257-9.  Back to cited text no. 4
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5.Ghallab NH, Alsabahi AA. Giant viable hydatid cyst of the lung: A case report. J Med Case Rep 2008;2:359.  Back to cited text no. 5
    
6.Saidi F. Treatment of Echinococcal cysts. In Masters of Surgery 3 rd edition.  Back to cited text no. 6
    
7.Yalcinkaya I, Er M, Ozbay B, Ugras S. Surgical treatment of hydatid cyst of the lung: Review of 30 cases. Eur Respir J 1999;13:441-4.  Back to cited text no. 7
    
8.Rai SP, Panda BN, Ganguly D, Bhardawaj R. Pulmonary hydatid: Diagnosis and response to hypertonic saline irrigation and albendazole. Med J Armed Force India 2005;61:9-12.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]


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