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Weekly Chest CasesArchive of Old Cases

Case No : 1086 Date 2018-08-20

  • Courtesy of Chul Hwan Park and Tae Hoon Kim / Gangnam Severance Hospital, Yonsei University College of Medicine
  • Age/Sex 37 / F
  • Chief ComplaintRussian
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Hydatid cyst
Radiologic Findings
Fig 1. Chest PA shows an approximately 2-cm, well-circumscribed and lobulated nodular opacity in the right para-cardiac area of the right lower lobe.
Fig 2. Chest CT images show an approximately 1.7-cm, well-defined, lobulated cystic nodule in the subpleural region of the right lower lobe without obvious enhancement. There are no enlarged lymph nodes in the mediastinum.
Fig 3. Abdominal CT image shows an approximately 5.5-cm, well-defined cystic mass in S5 of the liver, without internal septa or calcification.
CT, computed tomography.

Video-assisted thoracoscopic wedge resection was performed from the right lower lobe. On gross examination, the lesion was a well-demarcated, whitish, soft mass (2×1.5 cm). The final pathological diagnosis was unilocular cyst containing laminated membranes, favoring hydatid cyst.
Liver segmentectomy was also performed, and the pathological diagnosis was Echinococcosis hydatid cyst.

Brief Review
 Hydatid disease is a parasitic disease produced by the larval stage of the Echinococcus tapeworm. This disease occurs usually in the Mediterranean region, Africa, South America, the Middle East, Australia, and New Zealand. Dogs are the definitive hosts of Echinococcus tapeworms. Sheep, goat, and swine are intermediate hosts. Humans might become intermediate hosts by contacting a definitive host or ingesting contaminated water or vegetables. The eggs of the parasites pass through the intestinal wall, lodge in various organs via the portal venous system, and then form cystic lesions (hydatid cysts). The common sites of disease are the liver (75%) and lung (15%). Occasionally, it could involve the spleen, brain, heart, and kidneys. Pulmonary hydatid cysts are most common in the lower lobes (60%). They present in multiples in 30% of cases and bilaterally in 20% of cases. Typical findings are well-defined cystic lesions with fluid attenuation, homogenous content and smooth, hyperdense walls. Calcification is very rare in pulmonary cysts. Clinical symptoms depend on the location and size of cystic lesions. For small cysts, medical treatment (Albendazole) could be applied for the treatment. However, for large cysts, surgical resection should be considered.
References
1. Pedrosa I, Saiz A, Arrazola J, Ferreiros J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications. Radiographics : a review publication of the Radiological Society of North America, Inc. 2000;20(3):795-817.
2. Turgut AT, Altin L, Topcu S, Kilicoglu B, Aliinok T, Kaptanoglu E, et al. Unusual imaging characteristics of complicated hydatid disease. European journal of radiology. 2007;63(1):84-93.
3. Garg MK, Sharma M, Gulati A, Gorsi U, Aggarwal AN, Agarwal R, et al. Imaging in pulmonary hydatid cysts. World journal of radiology. 2016;8(6):581-7.
Keywords
Lung, Infection, Parasitic infection,

No. of Applicants : 93

▶ Correct Answer : 59/93,  63.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Prince Sattam ibn Abdulaziz University hospital , Saudi Arabia ELBAGIR MOHAMED NASSIR
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - eskisehir devlet hastanesi , Turkey MURAT SAHIN
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - , Japan NAOMI YUASA
  • - University of Florence , Italy MARIAELENA OCCHIPINTI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Kyoto Prefectural University of Medicine , Japan YOSHIAKI OTA
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
  • - , Korea (South) JANG SEONG WON
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Escola Paulista de Medicina , Brazil RENATO MASSON DE ALMEIDA PRADO
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - Other , Korea (South) WUNHA LEE
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Korea (South) JONGSUN LEE
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ajou University Hospital , Korea (South) YONG HO JANG
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Korea University Ansan Hospital , Korea (South) CHERRY KIM
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 7/93,  7.5%
  • - SQUH , Oman BADRIYA SALEH AL-QASSABI
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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