Hydatid disease of the lung: Demographic features, clinical presentation, radiologic features, and patient outcome after surgery in a tertiary care hospital in rural area

Vikas D Goyal

doi:10.4103/1116-5898.196258

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ORIGINAL ARTICLE

Year : 2016 | Volume : 26 | Issue : 1 | Page : 5-7

Hydatid disease of the lung: Demographic features, clinical presentation, radiologic features, and patient outcome after surgery in a tertiary care hospital in rural area

Vikas D Goyal
Department of Cardiothoracic and Vascular Surgery, Dr. Rajendra Prasad Govt. Medical College, Kangra, Tanda, Himachal Pradesh, India

Date of Acceptance	18-Mar-2016
Date of Web Publication	20-Dec-2016

Correspondence Address:
Vikas D Goyal
Department of Cardiothoracic and Vascular Surgery, Dr. Rajendra Prasad Govt. Medical College, Kangra, Tanda, Himachal Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1116-5898.196258

Abstract

Background: Retrospective analysis of the patients of hydatid disease of the lung. Patients and Methods: From November 2012 to October 2014, six patients of hydatid disease of the lung were referred to us. Their mean age, sex, presentation, radiological features, and outcome after surgery was evaluated. The study was conducted at Dr. Rajendra Prasad Govt. Medical College, Kangra at Tanda, India. Results: The ratio of male: female in the study was 5:1. Mean age of the patients was 32.50 ± 20.89 years. There was no operative mortality, and there was no recurrence. Follow-up was completed for all the patients in the study and mean follow-up time was 13.83 ± 05.56 months. Conclusion: Hydatid disease of the lung is more common in patients of poor socioeconomic status and those involved in cattle grazing and farming.

Keywords: Enucleation and capitonnage, hydatid disease, lung

How to cite this article:
Goyal VD. Hydatid disease of the lung: Demographic features, clinical presentation, radiologic features, and patient outcome after surgery in a tertiary care hospital in rural area. Niger J Surg Sci 2016;26:5-7

How to cite this URL:
Goyal VD. Hydatid disease of the lung: Demographic features, clinical presentation, radiologic features, and patient outcome after surgery in a tertiary care hospital in rural area. Niger J Surg Sci [serial online] 2016 [cited 2023 Mar 27];26:5-7. Available from: https://www.njssjournal.org/text.asp?2016/26/1/5/196258

Introduction

The aim of this study was to retrospectively evaluate the demographic features, clinical and radiological presentation, and outcome after surgery in cases of the hydatid disease of the lung. Hydatid disease is a zoonosis and humans are intermediate hosts. The disease is endemic in certain parts of the world and is more common in people of poor socioeconomic strata and those involved in cattle grazing and farming. ^[1] There are many large series reported from different parts of the world although it is endemic but there are few reported series on thoracic hydatid cysts from India. ^[2]

Hydatid disease most commonly involves liver ^[3] and lungs are the second most common site, other sites reported in the literature are pericardium, muscles, spleen, kidney, ^[3] pancreas, and brain. Majority of the patients of thoracic hydatid disease are asymptomatic initially but as the size enlarges, symptoms appear largely due to pressure or compression of adjacent structures. Patients usually present with chest pain, cough, breathlessness, and rarely with hemoptysis or expectoration of the cyst or its contents.

Hydatid disease of the lung is more common in patients of lower socioeconomic group and probable reasons are inadequate personal hygiene, contaminated water and food, and illiteracy. The disease is also more common in persons who are involved in upkeep of the animals and farming.

Patients and Methods

This is a retrospective study of six patients of hydatid disease of lung conducted in the Department of Cardiothoracic and Vascular Surgery at Dr. Rajendra Prasad Government Medical College Kangra at Tanda (Himachal Pradesh) from November 2012 to October 2014. In all the patients, diagnosis was established with chest radiographs [Figure 1]a and computed tomography (CT) of the chest [Figure 1]b apart from serological investigations. CT of the abdomen or ultrasonography of the abdomen was also done in each case to look for the simultaneous presence of other cysts in liver. The patients were operated under general anesthesia using single-lumen endotracheal tube. All patients underwent thoracotomy either anterolateral or posterolateral depending on the location of the cyst. In four patients, enucleation and capitonnage were done, [Figure 1]c and the other two patients, one underwent excision of the cyst, and other was treated with decortication, as the cyst had ruptured and got infected. Three patients had additional cysts in liver for which two patients also underwent laparotomy in the same sitting for the removal of additional cysts in liver. Their age, sex, socioeconomic status, occupation, presentation, radiological features, and outcome after surgery were evaluated.

Figure 1: (a) Chest radiograph showing well-defined rounded opacity in the left lower lobe. (b) Computed tomography chest showing homogenous cystic lesion in the left lower lobe. (c) Intraoperative photograph showing gross appearance of hydatid cyst being enucleated

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Results

The ratio of male: female in this study was 5:1. Mean age of the patients was 32.50 ± 20.89 years and majority of the patients were of poor socioeconomic status and were either related to farming or cattle grazing. Clinical features in majority of the patients were chest pain and cough. All patients underwent thoracotomy for removal of the cysts. Three patients had additional cysts in liver of which two patients also underwent laparotomy in the same sitting. There was no operative mortality, one patient required prolonged drainage from the abdominal drain and recovered subsequently. Follow-up was completed for all the patients in the study and mean follow-up time was 13.83 ± 05.56 months, and there was no recurrence of the disease at the same site or some other site. The data is shown in [Table 1].

Table 1: Data of the patients included in the study

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Discussion

Majority of the patients in this study were of poor socioeconomic status and were either involved in farming or cattle grazing, and they lived in poor hygienic conditions. This finding is in accordance with other reports mentioned in literature where people from poor socioeconomic status and professions involving cattle grazing were more frequently involved. One of the patients in this study had ruptured hydatid cyst leading to empyema, which later on required decortication and removal of the daughter cysts. Rupture into pleural cavity is a serious complication ^[4] of pulmonary hydatid cyst and can lead to increased morbidity ^[5] or even mortality.

Mean age of the patients reported in some large volume studies from literature ^[6],[7] Varied from 26 years to 35 years, and in our small series also the mean age of the patients was 32 ± 20 years. There are some reports in literature which show increased incidence of the disease in males, ^[8] other studies show either equal distribution between males and females or no significant gender difference, in our series males were more frequently involved. Whether the disease has any sex preponderance or not needs to be further investigated as there are conflicting reports available in the literature. Fifty percent of patients in our study had one or more additional cysts in the liver, and the most common radiological presentation was well-defined homogenous rounded opacity. Although disease is more prevalent in rural areas, some studies have also shown increased incidence of pulmonary hydatid disease in people from urban life and cities with uncontrolled population of dogs ^[9] and stray animals.

Surgery is the mainstay of treatment ^[10] combined with antiprotozoal medicines. Parenchyma-preserving surgery is preferred; however, some cases may require decortication, wedge resection, lobectomy, ^[11] or very rarely pneumonectomy for complicated cases. Enucleation of the cyst along with capitonnage has been the preferred treatment. ^[12] Studies in the literature show that morbidity after enucleation without capitonnage is more than enucleation with capitonnage, ^[13],[14] we performed capitonnage in four cases and had good results without any air leak or prolonged hospital stay. Mortality is negligible in majority of the studies and morbidity is minimal. Newer techniques such as puncture, aspiration, instillation, reaspiration and video-assisted thoracoscopic surgery (VATS) have also given good results and in future may compete with the open surgery as the first line of intervention depending on the location of the cyst. Some of the reports have indicated the advantages of VATS ^[15],[16] over conventional surgery by decreasing the morbidity but capitonnage of the cavity through VATS after enucleation may be difficult and incidence of air leak in the postoperative period needs to be further evaluated.

Conclusion

Surgery for removal of lung hydatid cyst is safe with mortality rates approaching 0%, and morbidity is also minimal. The disease is more prevalent in patients of lower socioeconomic group and persons involved in cattle grazing and farming are commonly affected.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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