Kilani T, Daoues A, Horchani H, Sellami M
Service de Chirurgie Thoracique, Hôpital A. Mami, Tunis.
Ann Chir. 1991;45(8):705-10.
The authors present 16 cases of hydatid cyst of the liver with rupture into the thorax, operated by thoracotomy. In 15 cases, the cyst ruptured into the right hemithorax and in one case, it ruptured into the left hemithorax. We adopted the classification proposed by our master S. Mestiri, which completes that proposed by Dévé. The diagnosis is essentially based on thoraco-abdominal ultrasonography, which visualises the hydatid cyst, reveals intrathoracic collections, demonstrates the diaphragmatic tear and studies the biliary tract looking for obstruction or dilatation. The diagnosis was established in 12 out of 16 cases. There were 3 postoperative deaths (18.7%): two from septic shock and one from cerebral vein thrombosis. Only one patient had to be operated via an abdominal incision one month after thoracotomy for cholangitis secondary to stones in the common bile duct which were not seen on the preoperative ultrasonography. Laparotomy is required whenever there is a biliary problem and may be sufficient in type 1 lesions. Thoracotomy is necessary whenever there is an intrathoracic collection (types II, III, IV) and is sufficient in the absence of any biliary tract lesions.
