CASE 2129 Published on 08.02.2007

A case of multisystem echinococcosis with a ruptured cystic component in the right lung

Section

Paediatric radiology

Case Type

Clinical Cases

Authors

Bozkurt Gulek, Sahin Ugurlu, Zeki Ziylan

Patient

6 years, female

Categories

No Area of Interest ; Imaging Technique CT

No Procedure ; No Special Focus ;

Show more Show less

Download as PDF Print Show related cases Notify admin

Clinical History

A six-year-old female patient complainted right chest pain and difficulty in breathing. X-ray and CT studies suggested a hydropneumothorax, the pattern of the fluid accumulation resembling that of a water-lily. CT findings of hepatic and splenic cysts helped in confirming the diagnosis.

Imaging Findings

The patient presented with complaints of right chest pain and difficulty in breathing. An initial chest X-ray revealed the presence of accumulated air and fluid in the right chest, giving the impression of a hydropneumothorax (Fig. 1). The right chest bottom showed a water-lily pattern. A leftward shift of the mediastinum was also noted. The CT image of the thorax confirmed these findings, and revealed pleural thickening in the right hemithorax as well (Fig. 2). A thoracocentesis was planned, but due to the coincidental findings of hepatic and splenic cysts on the CT scan (Fig. 3), a surgical approach was decided. The cysts were evacuated and were found to be of echinococcal nature. A ruptured hydatid cyst was discovered in the right hemithorax. The air was not due to a pneumothorax; instead it was due to a ruptured hydatid cyst. The patient recovered soon after surgery.

Discussion

Hydatid disease is a common problem in Turkey and some other European and Middle Eastern countries (1,2). The disease is caused by the parasite Echinococcus granulosus. Cyst formation is the typical outcome of the disease, and the lungs are frequently affected (1–5). The cysts have a characteristic fluid, known as 'rock water'. The cystic walls usually possess a cumulative membranous component, called 'germinative membrane', or 'cuticulum'. This may sometimes give the impression of a water-lily in lung X-rays and there may sometimes be intra-cystic smaller cysts, which are known as 'daughter cysts'. Hydatid cysts may sometimes rupture. The treatment is always surgical (1–5).

Differential Diagnosis List

Ruptured hydatid cyst in the right lung.

Final Diagnosis

Ruptured hydatid cyst in the right lung.

References

[1] 1. Koseoglu B, Bakan V, Onem O, Bilici S, Demirtas I. Conervative surgical treatment of pulmonary hydatid disease in children: an analysis of 35 cases. Surg Today. 2002;32(9):779-83. (PMID: 12203054)

[2] 2. Bouzid A, Nekmouche L, Benallegue S. Multifocal hydatid cysts in children. Chir Pediatr. 1986;27(1):33-6. (PMID: 3719886)

[3] 3. Balci AE, Eren N, Eren S, Ulku R. Ruptured hydatid cysts of the lung in children: clinical review and results of surgery. Ann Thorac Surg. 2002 Sep;74(3):889-92. (PMID: 12238856)

[4] 4. Sonmez K, Turkyilmaz Z, Demirogullari B, Ozen O, Karabulut R, Numanoglu V, Kale N, Basaklar AC. Hydatid cysts of the lung in childhood: is capitonnage advantageous? Ann Thorac Cardiovasc Surg. 2001 Feb;7(1):11-13. (PMID: 11343559)

[5] 5. Erdem CZ, Erdem LO. Radiological characteristics of pulmonary hydatid disease in children: less common radiological appearances. Eur J Radiol. 2003 Feb;45(2):123-8. (PMID: 12536091)

Case information

URL:	https://eurorad.org/case/2129
DOI:	10.1594/EURORAD/CASE.2129
ISSN:	1563-4086

Figure 1

PA chest X-ray

An X-ray, PA view, showing the accumulation of air and fluid in the right lung. There is hyperlucency of the right chest, a water-lily sign at the right chest bottom, and a shift of the mediastinum to the left.

Figure 2

CT scan

A CT axial image showing the changes in the right lung, with air and fluid accumulations. Again, note the water-lily sign at the right hemithorax, and a shift of the mediastinum to the left.

Figure 3

Lower thoracic CT scan