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Asian Cardiovasc Thorac Ann 2001;9:144-145
© 2001 Asia Publishing EXchange Pte Ltd

CASE STUDY

Intrathoracic Extrapulmonary Hydatid Cyst

Kazim Besirli, MD, Mohamad Said Burhani, MD, Caner Arslan, MD, Hasan Tüzün, MD, Kamil Kaynak, MD

Department of Thoracic and Cardiovascular Surgery
Cerrahpasa Faculty of Medicine
University of Istanbul
Aksaray, Istanbul, Turkey
For reprint information contact: Kamil Kaynak, MD Tel: 90 212 632 8474 Fax: 90 212 632 8474 email: kamil{at}istanbul.edu.tr Department of Thoracic and Cardiovascular Surgery, Cerrahpasa Faculty of Medicine, University of Istanbul, Aksaray, Istanbul 34300, Turkey.

   Abstract
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 Abstract
Introduction
 Case Report
 Discussion
 References
 
A 30-year-old man with a history of hepatic hydatid cyst was admitted with a mass lesion in the posterior mediastinum. Surgical intervention and subsequent pathological and microbiologic investigations revealed the mass to be a hydatid cyst located on the descending aorta in the posterior mediastinum and not invading the lung parenchyma. Albendazole treatment was added. No recurrence was seen in 15 months of follow-up.


   Introduction
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 Abstract
 Introduction
Case Report
 Discussion
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Entry of the eggs of Echinococcus granulosus in the alimentary canal of human beings causes cystic disease in the liver and lungs. This is the most common form of hydatid cyst. In our country, hepatic, pulmonary, and combined forms of hydatid cyst are seen frequently, while intrathoracic extrapulmonary hydatid cyst is very rare.


   Case Report
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 Abstract
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 Case Report
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A 30-year-old man who was operated upon 4 years earlier for hepatic hydatid cyst, was admitted with a 2-year history of blunt pain under the left scapula, on the anterior chest wall, and in the left upper quadrant of the abdomen, which had increased over the previous 4 months. Chest radiography revealed a left hilar mass with a regular contour (Figure 1Go). Computed tomography disclosed a lesion measuring 3 x 2 cm on the medial part of the posterior segment of the upper lobe of the left lung, and next to this in the mediastinum was a multiloculated mass lesion lying along the left paravertebral and paraaortic space. This mass displaced the descending aorta medially and the left main bronchus anteriorly (Figure 2Go). In addition, 2 cysts were detected in the right lobe of the liver. Enzyme-linked immunosorbent assay with immuno-globulin IgG and an indirect hemaglutination test for hydatid cyst were positive. On exploration via a left posterolateral thoracotomy, a hydatid cyst was found on the descending aorta. After cystotomy and partial decortication, pathological and microbiological examina-tions of the surgical material confirmed hydatid cyst. No postoperative complication was encountered. Albendazole 400 mg per day (Andazol; Biofarma, Istanbul, Turkey) was prescribed for 4 months and the patient was discharged on the 5th postoperative day. At follow-up 15 months after the operation, no recurrence was noted and the patient was symptomless and doing well.



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  		Figure 1. Chest radiograph showing a left hilar mass with a regular contour.

 


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  		Figure 2. Computed tomography scan of the chest. A cystic lesion can be seen in the left paravertebral and paraaortic space in the posterior mediastinum.

 

   Discussion
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References
 
Hendaoui and colleagues1 reported a case of hydatid cyst of 13 cm in diameter at the lower part of the thoracic aorta, associated with splenic and peritoneal disease. Errando and colleagues2 diagnosed an aortic hydatid cyst causing systemic embolization. Ranganadham and colleagues3 found that albendazole was very successful in the treatment and prevention of recurrence after cystotomy of posterior mediastinal hydatid cysts causing spinal compression and progressive paraplegia. Our case confirms the efficacy of albendazole in preventing recurrence in the mediastinum. Hydatid cyst should be kept in mind in the differential diagnosis of posterior mediastinal tumors, especially in patients with a history of hepatic echinococcosis.

Presented at the 5th National Thoracic and Cardiovascular Congress, Antalya, Turkey, October 20–4, 1998.


   References
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 Abstract
 Introduction
 Case Report
 Discussion
 References
 

  1. Hendaoui L, Siala M, Fourati A, Thameur MH, Hamza R. Case report: hydatid cyst of the aorta. Clin Radiol 1991; 43:423–5.[Medline]

  2. Errando CL, Ortaga MC, Hernandez S, Corona A, Justo P, Rodriguez G, et al. Mediastinal hydatidosis and cysto-aortic fistula with multiple systemic embolism. Rev Esp Anestesiol Reanim 1994;41:237–40.[Medline]

  3. Ranganadham P, Dinakar I, Sundaram C, Ratnakar KS, Vivekanada T. Posterior mediastinal paravertebral hydatid cyst presenting as spinal compression: a case report. Clin Neurol Neurosurg 1990;92:149–51.[Medline]





This Article
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Right arrow Mediastinum

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