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CASE REPORT
Year : 2008  |  Volume : 26  |  Issue : 1  |  Page : 80-81
 

Hydatid cyst of mediastinum


Department of Microbiology, G.B. Pant Hospital, New Delhi -110 001, India

Date of Submission17-Nov-2005
Date of Acceptance20-Apr-2007

Correspondence Address:
S Sehgal
Department of Microbiology, G.B. Pant Hospital, New Delhi -110 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.38867

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 ~ Abstract 

We report a case of hydatid cyst of the mediastinum in a 32-year-old female patient who was admitted with chest pain. CT scan reported posterior mediastinal mass towards the right side. Surgical exploration revealed a loculated cyst in posterior mediastinum on the right side, adherent to the overlying lung and underlying bone. Posterolateral thoracotomy was performed for cyst aspiration and excision. The patient was discharged on albendazole.


Keywords: Hydatid cyst, hydatid disease, mediastinal cyst, mediastinal echinococcosis


How to cite this article:
Sehgal S, Mishra B, Thakur A, Dogra V, Loomba P S, Banerjee A. Hydatid cyst of mediastinum. Indian J Med Microbiol 2008;26:80-1

How to cite this URL:
Sehgal S, Mishra B, Thakur A, Dogra V, Loomba P S, Banerjee A. Hydatid cyst of mediastinum. Indian J Med Microbiol [serial online] 2008 [cited 2019 Mar 26];26:80-1. Available from: http://www.ijmm.org/text.asp?2008/26/1/80/38867


Hydatid disease caused by Echinococcus granulosus , E. multilocularis and E. oligarthrus is an uncommon parasitic disease. [1] The disease poses a serious problem in India, where it is endemic. The primary hosts for the infecting organism are the members of the Canidae family, usually dogs, wolves and coyotes. The intermediate hosts are sheep, cattle and deer. Humans enter the cycle through infected canine faeces. Liver and lungs are the most common sites of infection, but it can also be seen elsewhere in the body. [2] Extrapulmonary location of the disease in the thorax is very rare. Intrathoracic extrapulmonary locations are generally the mediastinum, pleura, pericardium and chest wall. [3] We report a case of posterior mediastinal mass, which was provisionally diagnosed as bronchogenic cyst and later confirmed to be hydatid cyst of the posterior mediastinum.


 ~ Case Report Top


A 30-year-old lady was admitted to the cardiovasculothoracic surgery (CTVS) department with complaints of chest pain for the past 6 months. Pain started at the back radiating to the right lateral side of the chest below the nipple. Pain was constant and had a pinprick quality in nature without any change for the last six months. There was no history of trauma, fever, syncope, haemoptysis, haematemesis and dyspnoea on exertion. Laboratory tests were normal except for mild leucocytosis. CT scan of thorax showed a well-defined lobulated cystic lesion 6.2 × 4 × 4.2 cm in size at the right posterior mediastinum [Figure - 1]. The mass lesion was compressing the posterior segment of the upper lobe of the right lung; otherwise, the lung appeared normal. Abdominal ultrasonography (US) revealed a normal liver, spleen and gall bladder. A preoperative diagnosis of bronchogenic cyst was made. Posterolateral thoracotomy was performed and the lung retracted. The cyst was found adherent to the lung. The fluid aspirating from the cyst was straw-coloured and contained some particulate matter. Hence, it was sentfor microscopy to the Microbiology Department. Total cyst excision was performed, and the postoperative stay of the patient in the hospital was uneventful. Microscopy of the aspirated cystic fluid showed hooklets of Echinococcus granulosus . The patient was discharged on albendazole (400 mg once daily for one month).


 ~ Discussion Top


Hydatid disease has been acknowledged as an important clinical entity since ancient times. [4] The disease is a serious problem in India, where it is endemic. Although hydatid cysts are mostly seen in the liver and lungs, they may also be located in various tissues of the body. [2],[3] Extrapulmonary but intrathoracic hydatid cysts are very rare. [3] Cysts of bronchogenic, pleuropericardial, thymic, intramural, oesophageal, lymphangioma, anterior meningocele and enteric origin, as well as other rare types, may be found in the mediastinum of adults and children. [5] In one study, out of 1,619 intrathoracic hydatid cysts, only eight (0.5%) were situated in the mediastinum. [6] Primary hydatid cyst of the mediastinum, although extremely rare, is a distinct clinical entity, which must be considered in a patient with mediastinal mass in endemic regions. [7] In general, mediastinal echinococcosis is neither clinically nor radiologically distinguishable from other mediastinal cystic lesions. [8] Diagnosis can be reached after the combined assessment of clinical, radiological, historical and laboratory data of patients, as in the case presented here.

In conclusion, although very rare, hydatid disease should be considered in the differential diagnosis of a cystic lesion of the mediastinum, especially in endemic regions. Chest CT is the most efficient method of diagnosing these lesions. Surgical removal remains the treatment of choice for mediastinal echinococcosis. To avoid recurrence, additional adjuvant medical therapy is recommended.

 
 ~ References Top

1.Mirdha BR, Biswas A. Echinococcosis: Presenting as palpable lumps of breast. Indian J Chest Dis Allied Sci 2001;43:271.  Back to cited text no. 1    
2.Eren S, Ulku R Tanr?kulu C, Eren MN. Primary giant hydatid cyst of the diaphragm. Ann Thorac Cardiovasc Surg 2004;10:118-9.  Back to cited text no. 2    
3.Oguzkaya F, Akcali Y, Kahraman C, Emirogullari N, Bilgin MA. Unusually located hydatid cysts: Intrathoracic but extrapulmonary. Ann Thorac Surg 1997;64:334-7.  Back to cited text no. 3    
4.Aletras H, Symbas PN. Hydatid disease of the lung. In: Shields TW, LoCicero J, Ponn RB editors. General thoracic surgery, 5 th ed. Lippincott Williams and Wilkins: Philadelphia; 2000. p. 1113-22.  Back to cited text no. 4    
5.Erdogan A, Arife A, Demircan A. Two patients presenting with mediastinal mass. Breathe 2005;1:261-3.  Back to cited text no. 5    
6.Thameur H, Chenik S, Abdelmoulah S, Bey M, Hachicha S, Chemingui M, et al. Thoracic hydatidosis: A review of 1619 cases. Rev Pneumol Clin 2000;56:7-15.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Eroglu A, Kurkηuoglu C, Karaoglanoglu N, Tekinbas C, Kaynar H, Onbas O. Primary hydatid cysts of the mediastinum. Eur J Cardiothorac Surg 2002;22:599-601.  Back to cited text no. 7    
8.Davis RD Jr, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasms of the mediastinum: Recent changes in clinical presentation, methods of diagnosis, management and results. Ann Thorac Surg 1987;44:229-37.  Back to cited text no. 8  [PUBMED]  


    Figures

  [Figure - 1]

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