Management Strategies of Pulmonary Hydatid Cyst - A Prospective Observational Study

Introduction: Cystic echinococcosis better known as “hydatidcyst disease”, is caused by the helminth Echinococcusgranulosus. It has a worldwide distribution and is extremelycommon in the Indian Subcontinent. Lung is the second mostcommon organ of involvement after liver. In the present studywe aimed to clinically evaluate this disease and understand thevarious treatment modalities available for it.Material and methods: It was a prospective observationalstudy and statistical analysis was done wherever applicable.Present study comprised of 25 patients who attended withpulmonary hydatidosis at our hospital during a span of 18months.Results: The most common symptoms were cough and chestpain. The mean duration of illness (in years) was 2.4 ± 0.91(Mean ± SD). Computed tomography (CT) scan was done inall patients for confirming the diagnosis. Sixty percent hadhydatid cysts located in their right lung and had involvement ofthe lower lobe. Excision of cyst was done in 20 patients. Lungresection either in the form of segmentectomy or lobectomywas required in 32%. Intercostal chest drains were placed inall the patients during operation. In 10 patients the cumulativedaily drainage amount ranged between >75-100 ml. Thedifference in proportion of patients having <75% collectionin drain was not statistically significant. The intercostal chestdrains were removed between the 5th -10th postoperativedays in 15 patients. As sample size in each individual groupwas less than 5, Shapiro-Wilk test was applied to assess thedistribution pattern of the observation. The P value <0.05observed in patients without lung resection was statisticallysignificant. The difference in mean time of removal ofdrain following the different surgical interventions was notstatistically significant between the patients who requiredlung resection and those who did not. The distribution patternof the observation on duration of hospitalization amongstthe patients undergoing different surgical procedures (i.e.,those requiring resection of lung & those without any lungresection) were compared. The P value 0.004 observed inpatients without lung resection was statistically significant.Patient morbidity and mortality: 16 patients had air leakin their immediate postoperative period, which was thecommonest complication. There was no mortality in ourstudy.Conclusion: CT Scan is inevitable for confirmation ofdiagnosis. Surgery is the treatment modality of choice withpre- and postoperative albendazole therapy. Lung resectionmay be needed for selected patients and the most commoncomplication following surgery is air leak which can bemanaged conservatively.