Pulmonary echinococcosis mimicking Pancoast tumor

Abstract

Hydatid cyst disease is caused by the larval form of Echinococcus granulosus, and this parasitic infestation is an important health problem in endemic areas (Turkey, Middle Eastern countries, and South America). The lung and the liver are the most common sites of hydatidosis, but the parasite can be found in any part of the body except hair, teeth, and fingernails. Pulmonary hydatid cyst is sometimes mistaken for other pathologic processes according to location. We report the case of a surgically treated pulmonary hydatid cyst that clinically and radiologically mimicked Pancoast tumor.

Pancaost syndrome related to hydatid cyst

“…However, this clinical condition is very rarely associated with a pulmonary apex hydatid cyst including endemic area of echinoccosis [2, 4]. Like in our case, there is a good correlation between the clinico radiological presentation and the anatomic involvement [5].…”

“…Since it is a parasite disease, eosinophilia is present almost in 25% and serological diagnosis's sensitivity ranges between 40 and 90%. Serological diagnosis is more helpful in the diagnosis of reccurences [2, 4] and was positive in our case. The differential diagnosis above all in uncommon radiological aspect or complicated hydatid cyst includes other etiologies of Pancoast's syndrome mainly tumors, but also hematologic conditions, infectious diseases, neurogenic thoracic outlet syndromes (such as the cervical rib syndrome), and pulmonary amyloid nodule [1, 5].…”

“…It is caused by a direct pressure of the hydatid cysts on the sympathetic chain above all the stellate ganglion medial to the apex. Classic chest radiography and computed tomography (CT) are the main tools for radiologic diagnosis [2]. …”

“…This syndrome is commonly reported in neoplasm diseases and accounts for only 3% to 5% of all lung cancer presentations [1]. Although pulmonary hydatid cyst is still widespread throughout the world and remains an important public health issue in some regions (such as Middle Eastern, Turkey, South America and around Mediterranean borders) [2], it is very scarcely involved in the etiologies of this so called Pancoast syndrome. We report this uncommon case of Pancoast syndrome related to lung apex hydatid cyst occurring in a 38 year- old man who successfully underwent surgery in our department.…”

Current treatment concepts of Pancoast tumors

“…In all patients it is crucial to obtain histological proof before initiating treatment since not only NSCLC can present as on apical mass but also tumors of other origin such as metastases, sarcomas, lymphomas, tuberculosis or even echinococcus can present with similar clinical and radiological features [11][12][13][14][15].…”