Rare reason for pulmonary embolism: one case of pulmonary hydatid cyst and review of the literature

Abstract

Pulmonary embolism due to hydatid disease has been rare clinically. Here we present a patient case who suffered from multiple cystic hydatidosis within bilateral lung parenchyma and complicated bilateral pulmonary embolisms. The case was a 70-year-old man who complained of an increasingly severe cough and hemoptysis post-operation of hepatic hydatid cyst. Chest radiographs showed that the patient had multiple nodules in the bilateral chest. Computed tomography (CT) depicted that some lesions were multivesicular cysts and some consisting of sophisticated complications. CT pulmonary angiography revealed bilateral pulmonary arterial embolisms. T2-weighted magnetic resonance images (MRI) clearly demonstrated the daughter cysts inside the lesions with high intensive signal. Echinococcosis serologic testing was positive. Thus, the pulmonary embolism was caused by hydatid cyst based on the imaging findings and serologic test.

More than 200 hydatid cysts in the lung with a large number of daughter cysts: A rare case report

“…Diagnosis of hydatid cysts in the lung is primarily through radiographic investigations, such as Chest X-ray and CT scan [ 4 , 6 ]. Serological tests can be useful to confirm the diagnosis, but their sensitivity and specificity are low [ 1 ].…”

“…Radiographically, ruptured cysts may present as the water lily sign, crescent sign, air bubble sign, signet ring sign, or combo's sign [ 6 , 9 , 10 ]. Hepatic cysts should also be investigated by abdominal ultrasound or CT scan because liver involvement typically precedes lung involvement [ 4 ]. In this case, the chest-abdomen-pelvis CT scan showed multiple cysts in the lung, mediastinum, and liver.…”

“…Additionally, daughter cysts may form inside the lumen of the primary cysts [ 3 ]. Symptoms of hydatid cysts vary according to their size and location [ 4 ]. Radiologic and serologic investigations are the main methods for diagnosis [ 3 ].…”

Hydatid Pulmonary Embolism: A Case Report and Literature Review

“…It has been reported that echinococcosis of the pulmonary artery is mainly derived from hepatic hydatid cysts, and when these rupture in the liver or other organs in the abdomen, they invade the inferior vena cava or the hepatic vein. This enables the cyst contents to enter into the blood circulation and cause a pulmonary embolism after entering into the pulmonary artery and its branches through the right atrium and right ventricle [ 4 – 6 ]. By the time this situation occurs, the hydatid cyst is not usually seen in the right atrium or right ventricle, and most patients will have a history of hepatic hydatid disease.…”

Four pathways for hydatid pulmonary embolism

“…Hydatid disease or echinococcosis is a near‐cosmopolitan anthropozoonosis 1 . In humans, it is secondary to the development of the larval stage of a tapeworm called Echinococcus granulosus 2,3 .…”