Deshmukh Vikrant Suresh, Athavale Amita Umesh, Bhaskar Maheema Atul
Department of Chest Medicine and E.P.R.C., K.E.M. Hospital, Mumbai, Maharashtra, India.
J Bronchology Interv Pulmonol. 2009 Jul;16(3):172-5. doi: 10.1097/LBR.0b013e3181afcccb.
The diagnosis of unruptured pulmonary hydatidosis is based on classical radiologic features. However, ruptured or complicated hydatid cysts alter the radiologic signs and lead to delayed or incorrect diagnosis. The role of flexible bronchoscopy was assessed as a diagnostic tool in the evaluation in such cases. Between 2002 and 2008, 14 patients (7 female, 7 male), aged between 18 and 55 years, with a mean age of 36 years, were evaluated for pulmonary hydatidosis. Clinical history, radiologic findings, and other investigations of the patients were reviewed retrospectively at a tertiary referral center. All 14 patients were symptomatic, with cough, hemoptysis, and chest pain being the most common symptoms. Seven patients had right lung involvement, whereas 6 patients had left-sided predilection, and the remainder presented with pleural disease. At flexible bronchoscopy, white glistening membrane could be observed in 9 patients, whereas cytologic evaluation of bronchial washing did not show cuticular particles, degenerated scoleces, or hooklets in any of the cases. Twelve patients underwent uneventful surgical intervention. Surgical specimens showed 2 unruptured pulmonary hydatid cysts (uncomplicated), 1 pleural hydatid, and 9 ruptured pulmonary hydatid cysts. Of the 9 ruptured hydatid cyst cases, evidence of fungal (aspergillus) colonization, bacterial infection, and coexistent tuberculous granuloma was reported in 2 cases each. Bronchoscopy is an important tool that aids in confirming the diagnosis before surgery, especially in complicated pulmonary hydatidosis. Special stains for cytologic specimen should be used if the possibility of ruptured hydatid is thought to improve the diagnostic yield. The histopathology of the surgical specimen should be reviewed for associated secondary infection and fungal colonization.
未破裂型肺包虫病的诊断基于典型的放射学特征。然而，破裂或复杂的包虫囊肿会改变放射学征象，导致诊断延迟或错误。在这类病例的评估中，对可弯曲支气管镜作为诊断工具的作用进行了评估。2002年至2008年期间，对14例年龄在18至55岁之间、平均年龄为36岁的患者（7例女性，7例男性）进行了肺包虫病评估。在一家三级转诊中心对患者的临床病史、放射学检查结果及其他检查进行了回顾性分析。所有14例患者均有症状，咳嗽、咯血和胸痛是最常见的症状。7例患者右肺受累，6例患者左侧受累，其余患者表现为胸膜疾病。在可弯曲支气管镜检查中，9例患者可见白色发亮的膜，而支气管灌洗的细胞学评估在任何病例中均未显示角质颗粒、退化的头节或小钩。12例患者接受了顺利的手术干预。手术标本显示2例未破裂的肺包虫囊肿（无并发症）、1例胸膜包虫和9例破裂的肺包虫囊肿。在9例破裂的包虫囊肿病例中，各有2例报告有真菌（曲霉菌）定植、细菌感染和并存的结核性肉芽肿证据。支气管镜检查是一种重要的工具，有助于在手术前确诊，尤其是在复杂的肺包虫病中。如果认为有包虫破裂的可能性，应使用特殊染色对细胞学标本进行检查，以提高诊断率。应对手术标本的组织病理学进行检查，以查看是否存在相关的继发感染和真菌定植。
