IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Multiple Intrathoracic Hydatids
Jaswinder Singh, MCh,
Sandeep Singh Rana, MCh1,
Harkant Singh, MCh1,
Rajeshwar Sharma, MCh,
Vikas Sharma, MCh1
Department of Cardiovascular and Thoracic Surgery, Military Hospital (CTC), Golibar Maidan, Pune, India
1 Department of Cardiovascular and Thoracic Surgery Postgraduate Institute of Medical Education & Research Chandigarh, India
Jaswinder Singh, MCh Tel: +91 9767175186 Fax: +91 2024269427 Email: drjaswindersingh{at}yahoo.co.in, Department of Cardiovascular and Thoracic Surgery, Military Hospital (CTC), Golibar Maidan, Pune, India-411040.
A 37-year-old woman with persistent dry cough and recurrent pleural effusion, developed empyema after 10 months of antitubercular treatment. Chest radiography revealed an opacity in the left lateral chest wall (Figure 1
). Computed tomography showed multiple fluid collections with enhancing pleura and septa in the left pleural cavity, extending along the costal, mediastinal, and diaphragmatic pleura, with partial collapse of the left lung and central mediastinum, suggestive of left-sided multiloculated empyema and cystic pleural metastasis from adenocarcinoma/mesothelioma (Figure 2). On attempting decortication and drainage of the empyema through a standard left posterolateral thoracotomy, it was difficult to enter the pleural cavity because of very dense adhesions of the pleura and underlying lung to the chest wall. When trying to mobilize the lung, one of the loculations ruptured releasing multiple hydatid cysts of various sizes. The presence of empyema and the tubercular nature of the pleural fluid misled us; had we suspected hydatid disease, the management might have been conservative.
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Figure 1. Chest radiograph in posteroanterior view, showing a broad-based loculated homogenous opacity along the left lateral chest wall, extending from the apex to the costophrenic angle, with crowding of the ribs along the lower chest wall, and multiple nodular opacities in the upper, mid, and lower zones of the left lung.
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Figure 2. Computed tomography of the chest: (A) at the level of apex, showing multiple fluid collections; (B) at the level of outflow tract of the heart, showing multiple fluid collections with enhancing pleura and septa in the left pleural cavity, extending along the costal and mediastinal pleura; (C) at the beginning of the right dome of the diaphragm, showing multiple fluid collections with enhancing pleura and septa in the left pleural cavity, extending along the costal and mediastinal pleura; and (D) at the level of the diaphragm, showing multiple fluid collections filling the costophrenic angle.
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Asian Cardiovasc Thorac Ann 2010;
18:88-89
© 2010 by SAGE Publications
DOI: 10.1177/0218492309355197
