CASE 15329 Published on 26.12.2017

Extrahepatic manifestations of pulmonary hydatidosis. About a case in an endemic zone in South America, Chile

Section

Chest imaging

Case Type

Clinical Cases

Authors

Paula Valenzuela Labra1, Camila Valenzuela Labra2, Raul Valenzuela Labra3, Raul Valenzuela Lopez4, Soledad Acuña Garces4, Maria Jose Gonzalez Suarez4

1Faculty of Dentistry, Universidad de Los Andes/Chile,2Faculty of Nursing, Universidad de Los Andes/Chile, 3Radiology Service, Parral Hospital/Chile, 4Pediatric Service, Parral Hospital/Chile; Email:ravalenzuelalabra@gmail.com
Patient

14 years, male

Categories
Area of Interest Lung ; Imaging Technique Conventional radiography, CT
Clinical History

A 14-year-old young male patient from a rural area with a history of trauma was consulted for pain and haemoptysis in the emergency room.

Imaging Findings

Chest x-ray reveals presence of air-fluid level in the lower third of the left hemithorax. Computed tomography confirms the presence of a cystic lesion with air - fluid level, internal membranes "floating", serpinginous hyperattenuating membranes and pleural effusion. He undergoes surgery. Uncomplicated postoperative course.

Discussion

Background: Hydatid disease is a parasitic zoonosis produced by the larval stage of Echinococcus tapeworm [1].
Clinical perspective: This pathology is an endemic entity in some countries of the world, mainly in agricultural and livestock areas, South America [1] being an example, especially in Chile.
It is important to spread the imaging findings, since there are sectors in Europe with high infection rates, which may present similar manifestations (Mediterranean region). [1]
Imaging perspective: This disease affects the liver, presenting characteristic imaging findings. However, secondary involvement due to haematogenous dissemination may occur in almost every other part of the body (lung, kidneys, spleen, brain, bone). Pulmonary involvement is the most frequent site of haematogenous dissemination in children and the second in adults. [1]
Rupture of a cyst is the most frequent complication. [2]
The modalities of study are radiography and computed tomography. CT is the modality of choice for diagnosis of complicated hydatid cyst. [2]
Key findings: In X-ray the presence of an air-fluid level is a sign of a complicated cyst. In CT the presence of a cystic lesion with air-fluid level and floating membranes (water lily sign), serpinginous hyperattenuating membranes (“serpent sign”) and pleural effusion suggest a complicated cyst. [2]
Teaching points: Imaging of pulmonary complicated cyst in a patient in an endemic area.

Differential Diagnosis List
Ruptured pulmonary hydatid cyst (confirmed by biopsy)
Lung abscess
Tuberculosis
Final Diagnosis
Ruptured pulmonary hydatid cyst (confirmed by biopsy)
Case information
URL: https://eurorad.org/case/15329
DOI: 10.1594/EURORAD/CASE.15329
ISSN: 1563-4086
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