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Hydatid cyst of lung: An uncommon cause of chest pain in young Kalpana SR, Kumsi Sridhar1, Balaji Murugan1, Nagaraja Moorthy2, Manjunath C Nanjappa2 Departments of Cardiovascular Pathology, 1Cardiovascular and Thoracic Surgery, 2Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
ABSTRACT Echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs. Depending on the location of involvement it can have varied presentation. We describe a young adult presenting with chest pain secondary to a pulmonary giant hydatid cyst. A pulmonary hydatid cyst should be considered in the differential diagnosis of patients presenting with chest pain without conventional risk factors of coronary artery disease, especially in a tropical region. KEY WORDS: Chest pain, chest radiograph, echinococcosis Address for correspondence: Dr. Kalpana SR, Department of Cardiovascular Pathology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore ‑ 560 069, Karnataka, India. E‑mail: [email protected]
A 25‑year old male presented with history of recurrent retrosternal dull aching pain. He had no history of conventional risk factors of coronary artery disease. The electrocardiogram and transthoracic echocardiography were normal. Exercise treadmill test wan negative for inducible ischemia. Chest radiograph showed well‑demarcated homogenous rounded opacity in the right mid zone [Figure 1a] which was confirmed on chest computed tomography (CT), which showed a noncontrast‑enhancing solitary cyst occupying the right mid lobe [Figure 1b] measuring 85 × 65 × 80 mm. On right thoracotomy, the cyst was identified close to the hilum of the right lung attached to the lung parenchyma. The pearly white‑colored false capsule [Figure 2a] around the cyst was opened and the cyst was removed in toto. The cyst wall showed acellular gelatinous layers on microscopy [Figure 2b]. A wet mount preparation of hydatid sand with hematoxylin and eosin stain showed multiple protoscoleces [Figure 2c and d]. He was prescribed oral albendazole prior to surgery as well as for 3 months
post surgery to prevent recurrence. The post operative period was uneventful and he had complete relief from chest pain. Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs accounting for 90% of cases of echinococcosis.[1] Many hydatid cysts remain asymptomatic, even into advanced age. Parasite load, the site, and the size of the cysts determine the degree of symptoms. Radiographically, the cyst appears as a homogeneous spherical opacity with definite edges. CT scan with contrast may demonstrate a homogeneous
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a DOI: 10.4103/0970-2113.135770
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b
Figure 1: (a) Chest radiograph showing well circumscribed homogenous opacity in the right mid zone (b) Chest computed tomography showing non-contrast enhancing large cystic mass in the right hilum
Lung India • Vol 31 • Issue 3 • Jul - Sep 2014
Kalpana, et al.: Hydatid cyst of lung presenting with chest pain
a
b
cyst with a thin enhancing rim as shown in our case. On magnetic resonance imaging, cysts show low signal intensity on T1‑weighted images and high signal intensity on T2‑weighted images.[2] Ecchinococcosis of lung presenting as chest pain is very rare and should be considered in the differential diagnosis of chest pain in young individuals without conventional risk factors of atherosclerosis.
REFERENCES 1. 2.
c
d
Figure 2: (a) Pearly white cyst wall. (b) Microscopic image of a cyst wall showing acellular homogenous layers. (c and d) Microscopic image of hydatid sand with hematoxylin and eosin stain showing multiple protoscoleces
Harlaftis NN, Aletras HA, Symbas PN.Hydatid disease of the lung. In: Shields TW, editor.General Thoracic Surgery.Vol. 1. 6 thed. Philadelphia, PA: Lippincott Williams and Wilkins; 2005. p. 1298‑308. Singh S, Gibikote SV. Magnetic resonance imaging signal characteristics in hydatid cysts. AustralasRadiol 2001;45:128‑33.
How to cite this article: Kalpana SR, Sridhar K, Murugan B, Moorthy N, Nanjappa MC. Hydatid cyst of lung: An uncommon cause of chest pain in young. Lung India 2014;31:262-3. Source of Support: Nil, Conflict of Interest: None declared.
Lung India • Vol 31 • Issue 3 • Jul - Sep 2014 263
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Hydatid cyst of lung: An uncommon cause of chest pain in young Kalpana SR, Kumsi Sridhar1, Balaji Murugan1, Nagaraja Moorthy2, Manjunath C Nanjappa2 Departments of Cardiovascular Pathology, 1Cardiovascular and Thoracic Surgery, 2Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
ABSTRACT Echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs. Depending on the location of involvement it can have varied presentation. We describe a young adult presenting with chest pain secondary to a pulmonary giant hydatid cyst. A pulmonary hydatid cyst should be considered in the differential diagnosis of patients presenting with chest pain without conventional risk factors of coronary artery disease, especially in a tropical region. KEY WORDS: Chest pain, chest radiograph, echinococcosis Address for correspondence: Dr. Kalpana SR, Department of Cardiovascular Pathology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore ‑ 560 069, Karnataka, India. E‑mail: [email protected]
A 25‑year old male presented with history of recurrent retrosternal dull aching pain. He had no history of conventional risk factors of coronary artery disease. The electrocardiogram and transthoracic echocardiography were normal. Exercise treadmill test wan negative for inducible ischemia. Chest radiograph showed well‑demarcated homogenous rounded opacity in the right mid zone [Figure 1a] which was confirmed on chest computed tomography (CT), which showed a noncontrast‑enhancing solitary cyst occupying the right mid lobe [Figure 1b] measuring 85 × 65 × 80 mm. On right thoracotomy, the cyst was identified close to the hilum of the right lung attached to the lung parenchyma. The pearly white‑colored false capsule [Figure 2a] around the cyst was opened and the cyst was removed in toto. The cyst wall showed acellular gelatinous layers on microscopy [Figure 2b]. A wet mount preparation of hydatid sand with hematoxylin and eosin stain showed multiple protoscoleces [Figure 2c and d]. He was prescribed oral albendazole prior to surgery as well as for 3 months
post surgery to prevent recurrence. The post operative period was uneventful and he had complete relief from chest pain. Hydatid disease is a parasitic infestation by a tapeworm of the genus Echinococcus. Echinococcosis can involve any organ. The liver is the most common organ involved, followed by the lungs accounting for 90% of cases of echinococcosis.[1] Many hydatid cysts remain asymptomatic, even into advanced age. Parasite load, the site, and the size of the cysts determine the degree of symptoms. Radiographically, the cyst appears as a homogeneous spherical opacity with definite edges. CT scan with contrast may demonstrate a homogeneous
Access this article online Quick Response Code:
Website: www.lungindia.com
a DOI: 10.4103/0970-2113.135770
262
b
Figure 1: (a) Chest radiograph showing well circumscribed homogenous opacity in the right mid zone (b) Chest computed tomography showing non-contrast enhancing large cystic mass in the right hilum
Lung India • Vol 31 • Issue 3 • Jul - Sep 2014
Kalpana, et al.: Hydatid cyst of lung presenting with chest pain
a
b
cyst with a thin enhancing rim as shown in our case. On magnetic resonance imaging, cysts show low signal intensity on T1‑weighted images and high signal intensity on T2‑weighted images.[2] Ecchinococcosis of lung presenting as chest pain is very rare and should be considered in the differential diagnosis of chest pain in young individuals without conventional risk factors of atherosclerosis.
REFERENCES 1. 2.
c
d
Figure 2: (a) Pearly white cyst wall. (b) Microscopic image of a cyst wall showing acellular homogenous layers. (c and d) Microscopic image of hydatid sand with hematoxylin and eosin stain showing multiple protoscoleces
Harlaftis NN, Aletras HA, Symbas PN.Hydatid disease of the lung. In: Shields TW, editor.General Thoracic Surgery.Vol. 1. 6 thed. Philadelphia, PA: Lippincott Williams and Wilkins; 2005. p. 1298‑308. Singh S, Gibikote SV. Magnetic resonance imaging signal characteristics in hydatid cysts. AustralasRadiol 2001;45:128‑33.
How to cite this article: Kalpana SR, Sridhar K, Murugan B, Moorthy N, Nanjappa MC. Hydatid cyst of lung: An uncommon cause of chest pain in young. Lung India 2014;31:262-3. Source of Support: Nil, Conflict of Interest: None declared.
Lung India • Vol 31 • Issue 3 • Jul - Sep 2014 263
Copyright of Lung India is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
