Department of Medicine, University of Manitoba, Winnipeg, Manitoba.
Can Respir J. 2011 Sep-Oct;18(5):258-60. doi: 10.1155/2011/197642.
Cystic echinococcosis is observed worldwide. Traditional management includes an invasive surgical approach with adjunctive chemotherapy. It has been suggested that observation alone may be appropriate in asymptomatic individuals with stable cysts. A case involving a 38-year-old Peruvian man with an asymptomatic bronchogenic cyst (suspected to be due to echinococcus, but never definitely diagnosed) is presented. The cyst was first noted in 1998, and was followed for 10 years during which time he remained asymptomatic with minimal radiographic change. One year later, in 2009, he presented with acute rupture of the cyst causing empyema. The patient required thoracotomy, decortication and resection of the ruptured cyst. Final pathology showed Echinococcus organisms. The patient responded well to treatment with albendazole and praziquantel, and became completely asymptomatic within six months. The present case demonstrates that echinococcal cysts may be at risk of spontaneous rupture, even after many years of clinical stability, thus supporting the case for resection of asymptomatic cysts suspected of being echinococcal at the time of diagnosis. In addition, the case illustrates that medical therapy with albendazole and praziquantel, in conjunction with surgical drainage, can be successful in the treatment of echinococcal empyema.
包虫病在全球范围内都有发生。传统的治疗方法包括有创的外科手术，并辅以化疗。有研究表明，对于无症状且囊肿稳定的个体，单纯观察可能是合适的。本文报告了一例秘鲁 38 岁男性无症状的支气管源性囊肿（疑似包虫病，但从未确诊）病例。该囊肿于 1998 年首次发现，在随后的 10 年期间，他一直无症状，影像学变化极小。一年后，即 2009 年，他因囊肿急性破裂导致脓胸而就诊。患者需要行开胸术、去皮质术和破裂囊肿切除术。最终的病理检查显示为包虫组织。患者对阿苯达唑和吡喹酮治疗反应良好，在六个月内完全无症状。本病例表明，即使在多年的临床稳定后，包虫囊肿也可能有自发破裂的风险，因此支持在诊断时怀疑为包虫囊肿时进行切除的观点。此外，该病例还表明，阿苯达唑和吡喹酮联合手术引流的药物治疗可以成功治疗包虫性脓胸。
