Surgical treatment for pulmonary hydatidosis (a review of 422 cases)

Hydatidosis in man is frequently encountered in sheep and cattle raising regions of the world. We reviewed 422 patients, treated surgically for pulmonary hydatid disease in our clinic between January 1980 and January 1998, assessing the clinical features and results of results of operative treatment management in our centre.

52 of the patients were female and 370 were male. The median age of the patients was 33 years (range, 11 to 66 years). The cysts were located in the right lung in 214 (50.7%) patients, the left lung in 156 (37%) and bilaterally in 17 (4%) cases. We found an intrathoracic extrapulmonary cyst in 35 (8.3%) patients. We performed enucleation and capitonnage in 202 cases, wedge resection in 40, cystotomy and capitonnage in 171, and lobectomy in 9 patients. The high-risk patients were treated with Albendazol (10 mg/kg/day), for a period of 3 months postoperatively.

Preoperative diagnosis was based primarily on chest roentgenograms and led to correct diagnosis in 347 cases (82.2%). An additional computerised tomography (CT) scan in 56 cases and magnetic resonavive imaging (MRI) were required in 15 cases. The diagnosis is established intraoperatively in 4 cases. Most (296) patients presented with a solitary lung cyst. The rest were found to have multiple cysts in one or more lobes. 87 of 422 also had cysts in the liver, 19 in the spleen, and 1 in the pancreas. The follow-up data was completed in 392 of 422 (92.8%) patients. The mean follow-up period was 4.3 years (2 to 19 years). We detected recurrence in 3 patients (0.71%).

The effective treatment of hydatid cyst(s) in the lung is complete excision of the cyst(s) with maximum preservation of the lung parenchyma. Additional medical treatment with Albendazole should be carried out for high-risk group patients.