Accepted Manuscript Title: Acute pulmonary embolism due to hydatid cysts Author: Walid Mnari Ahmed Zrig Mezri Maatouk Mondher Golli PII: DOI: Reference:
S1201-9712(14)01479-9 http://dx.doi.org/doi:10.1016/j.ijid.2014.03.1385 IJID 1957
To appear in:
International Journal of Infectious Diseases
Received date: Revised date: Accepted date:
22-2-2014 14-3-2014 20-3-2014
Please cite this article as: Mnari W, Zrig A, Maatouk M, Golli M, Acute pulmonary embolism due to hydatid cysts, International Journal of Infectious Diseases (2014), http://dx.doi.org/10.1016/j.ijid.2014.03.1385 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
[ARTICLE TYPE – MEDICAL IMAGERY]
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Acute pulmonary embolism due to hydatid cysts
A 41-year-old male was admitted to our department for progressive chest pain. There
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was no history of cardiovascular diseases. He was a butcher in a rural area. Physical
us
examination was unremarkable. Electrocardiogram (ECG) traces demonstrated a sinus tachycardia. The D-dimer test was normal. A pulmonary embolism was clinically
an
suspected. A computed tomography (CT) pulmonary angiogram revealed complete occlusion of the left pulmonary artery by a mass with fluid density (Figure 1). Cardiac
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magnetic resonance imaging (MRI) showed multivesicular cysts in the left pulmonary artery, with a characteristic low-intensity rim surrounding the homogeneous and high
d
signal cyst content (Figure 2). Based on the radiological findings, a diagnosis of
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pulmonary embolism due to hydatid cysts was made. An abdominal ultrasound showed two typical hydatid cysts in the liver (Figure 3). The patient underwent
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surgery including a left lower lobectomy with left atriotomy to remove the proximal hydatid cysts. The diagnosis was confirmed by histopathological examination. The postoperative course was uneventful. The patient was discharged on a regimen of albendazole, 800 mg daily for four cycles (1 month cycle followed by a 2-week albendazole-free interval), as treatment against hepatic hydatidosis and eventual pulmonary dissemination. The patient has been followed up closely and is now asymptomatic. Hepatic cyst surgery will be performed by the end of chemotherapy.
[Figures 1–3 here]
Page 1 of 7
Pulmonary hydatid cyst embolization is a rare complication of cardiac or hepatic echinococcosis.1 It can be mistaken for pulmonary embolism based on the similar clinical manifestations of hemoptysis and acute onset of chest pain.2 Both
pulmonary artery and its branches, as happened in our case.3
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spiral CT and MRI angiography can clearly disclose cystic occlusion of the
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Conflict of interest: No conflict of interest to declare. No funding source to
us
declare.
Jorens PG, Van Marck E, Snoeckx A, Parizel PM. Nonthrombotic pulmonary
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1.
an
References
embolism. Eur Respir J 2009;34:452–74.
Namn Y, Maldjian PD. Hydatid cyst embolization to the pulmonary artery: CT
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2.
3.
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and MR features. Emerg Radiol 2013;20:565–8. Bayaroğullari H, Davran R, Cavuş Y, Yetim TD, Evirgen Ö. Liver hydatid
Ac ce p
cyst leading to bilateral pulmonary artery embolism and bilateral multiple pulmonar echinococcosis via inferior vena cava: report of a case. Clin Imaging 2013;37:374–8.
Walid Mnari*, Ahmed Zrig, Mezri Maatouk, Mondher Golli
Imaging Department, FB University Hospital, Avenue Farhat Hachad 5000, Monastir, Tunisia
Correspondence footnote:
Page 2 of 7
*Corresponding author. Tel.: +216 98 677200; fax: +216 73 460678. E-mail address: [email protected]
[Received date]
Ac ce p
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M
an
us
Corresponding Editor: Eskild Petersen, Aarhus, Denmark
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(W. Mnari).
Page 3 of 7
Figure captions
Figure 1
Axial view (panel A) and sagittal view (panel B) of a spiral CT
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pulmonary angiogram showing complete occlusion of the left main pulmonary artery
Figure 2
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by a mass, with fluid density extending across the segmental arteries (arrows).
Axial (panel A) and sagittal (panel B) gradient echo T2-weighted MRI
us
showing multivesicular cysts in the left pulmonary artery with a characteristic low-
Ultrasound image showing typical multivesicular hydatid cyst in the liver:
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Figure 3
an
intensity rim surrounding the homogeneous and high signal cyst content (arrows).
a well-defined fluid collection in a honeycomb pattern, with multiple septa
d
representing the walls of the daughter cysts (arrows). The hydatid fluid contains
Ac ce p
te
sediment (large arrow) of broken daughter vesicles and hydatid sand.
Page 4 of 7
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*Fig 1
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*Fig 2
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*Fig 3
Page 7 of 7
S1201-9712(14)01479-9 http://dx.doi.org/doi:10.1016/j.ijid.2014.03.1385 IJID 1957
To appear in:
International Journal of Infectious Diseases
Received date: Revised date: Accepted date:
22-2-2014 14-3-2014 20-3-2014
Please cite this article as: Mnari W, Zrig A, Maatouk M, Golli M, Acute pulmonary embolism due to hydatid cysts, International Journal of Infectious Diseases (2014), http://dx.doi.org/10.1016/j.ijid.2014.03.1385 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
[ARTICLE TYPE – MEDICAL IMAGERY]
ip t
Acute pulmonary embolism due to hydatid cysts
A 41-year-old male was admitted to our department for progressive chest pain. There
cr
was no history of cardiovascular diseases. He was a butcher in a rural area. Physical
us
examination was unremarkable. Electrocardiogram (ECG) traces demonstrated a sinus tachycardia. The D-dimer test was normal. A pulmonary embolism was clinically
an
suspected. A computed tomography (CT) pulmonary angiogram revealed complete occlusion of the left pulmonary artery by a mass with fluid density (Figure 1). Cardiac
M
magnetic resonance imaging (MRI) showed multivesicular cysts in the left pulmonary artery, with a characteristic low-intensity rim surrounding the homogeneous and high
d
signal cyst content (Figure 2). Based on the radiological findings, a diagnosis of
te
pulmonary embolism due to hydatid cysts was made. An abdominal ultrasound showed two typical hydatid cysts in the liver (Figure 3). The patient underwent
Ac ce p
surgery including a left lower lobectomy with left atriotomy to remove the proximal hydatid cysts. The diagnosis was confirmed by histopathological examination. The postoperative course was uneventful. The patient was discharged on a regimen of albendazole, 800 mg daily for four cycles (1 month cycle followed by a 2-week albendazole-free interval), as treatment against hepatic hydatidosis and eventual pulmonary dissemination. The patient has been followed up closely and is now asymptomatic. Hepatic cyst surgery will be performed by the end of chemotherapy.
[Figures 1–3 here]
Page 1 of 7
Pulmonary hydatid cyst embolization is a rare complication of cardiac or hepatic echinococcosis.1 It can be mistaken for pulmonary embolism based on the similar clinical manifestations of hemoptysis and acute onset of chest pain.2 Both
pulmonary artery and its branches, as happened in our case.3
ip t
spiral CT and MRI angiography can clearly disclose cystic occlusion of the
cr
Conflict of interest: No conflict of interest to declare. No funding source to
us
declare.
Jorens PG, Van Marck E, Snoeckx A, Parizel PM. Nonthrombotic pulmonary
M
1.
an
References
embolism. Eur Respir J 2009;34:452–74.
Namn Y, Maldjian PD. Hydatid cyst embolization to the pulmonary artery: CT
d
2.
3.
te
and MR features. Emerg Radiol 2013;20:565–8. Bayaroğullari H, Davran R, Cavuş Y, Yetim TD, Evirgen Ö. Liver hydatid
Ac ce p
cyst leading to bilateral pulmonary artery embolism and bilateral multiple pulmonar echinococcosis via inferior vena cava: report of a case. Clin Imaging 2013;37:374–8.
Walid Mnari*, Ahmed Zrig, Mezri Maatouk, Mondher Golli
Imaging Department, FB University Hospital, Avenue Farhat Hachad 5000, Monastir, Tunisia
Correspondence footnote:
Page 2 of 7
*Corresponding author. Tel.: +216 98 677200; fax: +216 73 460678. E-mail address: [email protected]
[Received date]
Ac ce p
te
d
M
an
us
Corresponding Editor: Eskild Petersen, Aarhus, Denmark
cr
ip t
(W. Mnari).
Page 3 of 7
Figure captions
Figure 1
Axial view (panel A) and sagittal view (panel B) of a spiral CT
ip t
pulmonary angiogram showing complete occlusion of the left main pulmonary artery
Figure 2
cr
by a mass, with fluid density extending across the segmental arteries (arrows).
Axial (panel A) and sagittal (panel B) gradient echo T2-weighted MRI
us
showing multivesicular cysts in the left pulmonary artery with a characteristic low-
Ultrasound image showing typical multivesicular hydatid cyst in the liver:
M
Figure 3
an
intensity rim surrounding the homogeneous and high signal cyst content (arrows).
a well-defined fluid collection in a honeycomb pattern, with multiple septa
d
representing the walls of the daughter cysts (arrows). The hydatid fluid contains
Ac ce p
te
sediment (large arrow) of broken daughter vesicles and hydatid sand.
Page 4 of 7
Ac
ce
pt
ed
M
an
us
cr
i
*Fig 1
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*Fig 2
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*Fig 3
Page 7 of 7
