Occult hydatid disease presenting as a spontaneous pneumothorax

Abstract

Pneumothorax is a rare complication of pulmonary hydatid disease and has been reported only once in Britain (Connellan et al, 1979), although it has been described in areas where the disease is endemic (Waddle, 1950; Tomalino, 1959; Bakir & Al-Omeri, 1969; Xanthakis et al, 1972). A case is described in which a patient with hydatid disease presented with a spontaneous pneumothorax. The diagnosis was not made until he underwent thoracotomy and lung biopsy following the development of secondary lung parenchymal and pleurai cysts a year later. A previously fit 22-year-old non-smoking mechanic from the Isle of Skye presented with a history of mild pleuritic left-sided chest pain associated with an incessant cough and slight effort dyspnoea. His symptoms were not alleviated by antibiotic therapy. A chest radiograph taken two months later showed a left-sided tension pneumothorax. After transfer to the regional hospital he was treated with an intercostal suction drain for two weeks. The pneumothorax resolved slowly and the patient was sent home well. The chest radiograph at this time showed fully expanded lungs but also a minimal opacity projected over the left hilum. On the three month follow-up, the radiographic appearances were unchanged. After six months had elapsed the final check radiograph revealed, in addition, a discrete, well-defined opacity 1.0 cm in diameter in the left mid-zone anteriorly (Fig. 1), although the patient now felt fit and was working normally.

Intestinal hydatidosis in unusual location: A case report

“…Humans are accidental intermediate hosts infected by ingestion of food contaminated with eggs shed by dogs or foxes and are common in rural areas. Eggs hatch in the duodenum and enter the mesenteric venules and become lodged in the capillary filter bed in various organs except for hair, teeth or finger nails [5]. The most important site is liver (70%), lung (15%), kidney (3%), spleen (4%), cerebrum (2%) and heart (0.02-2%).…”

“…In a study of 2,013 patients by the Tunisian Surgical Association, the mean age was 32 years [9]. Ayadi-Kaddour et al reported a case in which the patient was 66 years old [5]. Clinical manifestations of hydatidosis in humans are variable.…”

“…Morbidity and mortality in patients with perforated hydatid cyst are higher than in those with nonperforated cysts. Mortality rate is variable, ranging from 0-20% in published reports of perforated cyst [5].…”

Parasitic Infections of the Pleural Space

“…In the absence of local pleural adhesions, a spontaneous pneumothorax results. [82][83][84] Although not common, Xanthakis and colleagues 71 found spontaneous pneumothorax as the first manifestation of illness in 3 of 91 patients with hydatid disease of the chest. If the collapsed pericyst acts as a valve, a tension pneumothorax may develop, resulting in mediastinal shift.…”

“…84 Since rupture is more often found in small than in large cysts, 71 the cause of the pneumothorax may not be readily apparent unless additional intact hydatids are demonstrated radiographically. 83,84…”