Racil H, Ben Amar J, El Filali Moulay R, Ridene I, Cheikrouhou S, Zarrouk M, Chaouch N, Chabbou A
Service de Pneumologie-allergologie, pavillon II, Hôpital Abderrahmen Mami, Ariana, Tunisie.
Rev Mal Respir. 2009 Sep;26(7):727-34. doi: 10.1016/s0761-8425(09)72423-4.
Hydatid disease which is caused by the parasite Echinococcus granulosis is one of the most important helminthic diseases. The parasitic infection is endemic in many areas worldwide, including the Mediterranean region. The lung is the second most common involved organ. In the present study, we review cases of complicated pulmonary hydatidosis, discussing pathophysiological mechanisms and the clinical, radiological features, as well as natural history and therapeutic options.
A retrospective study was conducted in the adult pulmonary department of The Tunis Chest Diseases and Surgery Training Hospital, a tertiary referral hospital for pulmonary diseases in Tunisia.
52 cases (mean age=34.6 years) were evaluated between 1998 and 2008. Rupture of the hydatid cyst occurred into the bronchi in the majority of cases (86.5%) and into the pleura in 9.6%. Extrathoracic involvement was found in 17.3% of the cases. Diagnosis of pulmonary hydatidosis was based on a consistent clinical and radiological presentation. Recourse to CT scan of the chest was helpful for diagnosis in 28% of the patients. Fibre-optic bronchoscopy (performed in 64.5% of cases) confirmed the diagnosis in 4 patients with total endoscopic extraction of hydatid cyst membrane in 2 cases. Surgical treatment was performed in 44 cases; resection of lung parenchyma was necessary in 8 patients (18.2%). Medical treatment was associated in 2 cases. Outcome revealed recurrence of pulmonary hydatidosis in 3 patients, and the death of 1 patient with chronic pulmonary hypertension due to chronic hydatid pulmonary embolism.
Complicated pulmonary hydatidosis may present some diagnostic difficulties, even in endemic regions. Management may be difficult, costly, and may require pulmonary resections.
由细粒棘球绦虫寄生虫引起的包虫病是最重要的蠕虫病之一。这种寄生虫感染在世界许多地区呈地方性流行，包括地中海地区。肺是第二常见的受累器官。在本研究中，我们回顾了复杂型肺包虫病的病例，讨论了其病理生理机制、临床和放射学特征，以及自然病程和治疗选择。
在突尼斯胸部疾病与外科培训医院的成人肺部科室进行了一项回顾性研究，该医院是突尼斯一家三级肺病转诊医院。
在1998年至2008年期间评估了52例患者（平均年龄=34.6岁）。大多数病例（86.5%）的包虫囊肿破裂进入支气管，9.6%进入胸膜。17.3%的病例有胸外受累。肺包虫病的诊断基于一致的临床和放射学表现。胸部CT扫描对28%的患者诊断有帮助。纤维支气管镜检查（64.5%的病例进行了此项检查）确诊了4例患者，其中2例通过内镜完全取出了包虫囊肿膜。44例患者接受了手术治疗；8例患者（18.2%）需要切除肺实质。2例患者联合了药物治疗。结果显示3例患者出现肺包虫病复发，1例因慢性包虫性肺栓塞导致慢性肺动脉高压的患者死亡。
即使在流行地区，复杂型肺包虫病也可能存在一些诊断困难。治疗可能困难、昂贵，且可能需要进行肺切除术。
