Surgical treatment and follow-up of pulmonary hydatid cyst

To report our experience of surgical procedures in the management of hydatid cysts of the lung and to assess the effect of postoperative chemotherapy.

In a longitudinal cohort study, 64 consecutive patients who presented with hydatid cysts of the lung from 1994 to 1998 were included. The main measures were: characteristics on presentation, operative techniques, postoperative morbidity, and the outcome of treatment. The mean age was 28 years (range 4-65 years). The most common symptoms were cough, chest pain, fever, and hemoptysis. Chest radiographs and computed tomograms were the main method of diagnosis. Pulmonary cystotomy and capitonnage were performed in 46 patients. Pulmonary resection was needed in 8 of 64 patients. Simultaneous combined resection of hydatid cysts through thoracotomy with transdiaphragmatic removal of liver cysts was performed in one stage in 13 patients.

Chest radiographs and CT scans showed a smoothly outlined spherical opacity in 45 patients. Other radiographic findings included ill-defined shadow (in 8 patients), pleural effusion (7 patients), air fluid level (3 patients), and hydropneumothorax in a single patient. There were 8 (12.5%) cases of immediate postoperative complications. These occurred mostly in patients who had cysts larger than 10 cm (p = 0.003). Thirty-four patients were treated by a 3-month course of albendazole chemotherapy. Four patients (6%) had recurrences of the disease during the follow-up period. These recurrences occurred in patients with large cysts >10 cm (p = 0.001).

Conservative surgical methods are the preferred surgical techniques. Postoperative chemotherapy with albendazole for 3 months is recommended.