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