Hydatid disease of the liver with thoracic involvement.

Eleven patients with hydatid disease of the liver with intrathoracic involvement have been treated at this hospital, and another patient was treated previously elsewhere. The clinical and roentgenologic symptoms depend greatly upon the evolutionary stage of the disease. General conditions are seriously affected in instances of ruptured and infected cysts. When the cysts open into the tracheobronchial tree as a result of coughing up pus in profuse quantities, the general condition may improve to a certain degree, but bronchopulmonary symptoms increase at that moment. An important spitting of bile must alert us to the existence of biliary hypertension. This condition must be treated first to avoid recurrence of the process. According to our experience, surgical treatment is based upon correct drainage of the cystic intrahepatic cavity under the diaphragm, separating the pleural cavity completely from the intrahepatic; excision of the transdiaphragmatic fistulous tract; conservative indications for pulmonary resection, and possible existence of biliary hypertension before and after operation.