REFERENCES 1 Gordon AS: Improved esophageal obturator airway (EOA) and new esophageal gasbic tube airway (EGTA). In Safar P (ed) : Advances in Cardiopulmonary Resuscitation. New York, Springer-Verlag, !f117, pp 58-63 2 Gordon AS: Clinical experiences with the esophageal obturator airway (EOA) and esophageal gastric tube airway (EGTA). Read before the Third Annual UCLA Postgraduate Institute on Emergency Medicine, Los Angeles, Ian 3O-Feb 3, 1978 3 Don Michael TA: Esophageal obturator airway. Med Instrum 11:331-333, 1977 4 Schofferman I, Oill P, Lewis AI: The esophageal obturator airway: A clinical evaluation. Chest 69:67-71, 1976 5 Don Michael TA, Gordon AS, Schofferman I: Esophageal obturator airway: A new adjunct in emergency airway management (abstract) . Am I CardioI39:259, 1977 6 White RD, Gilles BP: Endotracheal vs esophageal intubation. Emergency 10:49-51, 1978 7 Iohnson KR, Genovesi MG, Lassar KII : Esophageal obturator airway: Use and complications. IACEP 5:36-39, 1976 8 Bryson TK, Benumof JL, Ward CF: The esophageal obturator airway: A clinical comparison to ventilation with a mask and oropharyngeal airway . Chest 74:537-539, 1978 9 Safar P, in discussion, Gordon AS: Improved esophageal obturator airway (EOA) and new esophageal gastric tube airway (EGTA). In Safar P (ed): Advances in Cardiopulmonary Resuscitation. New Yorlc, Springer-Verlag, 1977,p 63 Reprint requeBt8: Dr. Benumof, Anesthesia R&eat'Ch LabortJ,.. forJI, UnIoerritv of Callfomla (SD). La lolla 92093

Giant Primitive Pleural Hydatid Cyst To the Editor: We present the radiologic findings observed in a patient

with a giant primitive pleural hydatid cyst which was con6rmed at thoracotomy.

CASE REPoRT Our patient was hospitalized because of a continuous pain in the right side of his chest. Physical examination revealed a decrease in the motlUty of the right hemithorax, dullness to percussion, and abolished transmission of breath sounds . The roentgenogram showed a large and sharply marginated mass occupying the right lower hemithorax. Six days after admission, the patient suHered the abrupt onset of chills, followed by fever and expectoration of vomica that persisted for four days. After these episodes of vomica, the roentgenographic studies were repeated, showing a huge cavity occupied by multiple rounded and sharply circumscribed shadows that formed an undulated air-fluid level. The tomogram revealed the mobilization of these vesicles into the cavity (Fig 1). Analytical studies showed marked eosinophiUa and a positive Casoni's intradermal test. These radiologic and laboratory findings pointed to a diagnosis of pleural primitive hydatid disease. At thoracotomy a cystic cavity localized in the pleural space was found, containing multiple hydatid daughter vesicles.

614 COMMUtllCAnOIlS TO THE EDITOR

FiCUBE 1. Tomogram of right hemithorax after vomica, showing mobilization of daughter hydatid vesicles.

DlSCUSSION

Pleural primitive hydatid cyst can be considered to account for 1 percent of all thoracic hydatid disease. 1 Most reported cases are seen as little and homogeneous densities, and the diagnosis of primitive disease was always confirmed at surgery. The mobilization of the daughter vesicles has been considered a sign of secondary pleural hydatid disease, 2 and to our knowledge, such mobilization has not been observed in the primitive form; however, in our patient, primitive pleural localization was confirmed at thoracotomy. We think that the peculiarities observed in this case, such as vomica and mobilization of daughter vesicles into the cavity, are a consequence of the huge size of the hydatid cyst, and we can conclude that these signs cannot reject the primitive origin of the pleural hydatid disease.

1.M. Antona GOmez, M.D.; G. Garcfa-Vinuesa. M.D.;

F. Fuentes Otero, M.D.; 1. M. ChecaPintUa, M.D.; andM. Miranda, M.D. Deparlment of Internal Medicine, University Exttemaduta. Badaicn. Spaln

perez

1b:FERENCES 1 Martinez Apeztegu{a IL: InterpleuroparietaI hydatid dlsease. Thorax 19:192,1970 2 Picardo CasteI16n M: Pleural complications of hydatid disease. An Acad Med Quirurg Esp 48:11,1964

CHEST, 76: 5, NOVEMBER, 1979