The diagnostic value of fiberoptic bronchoscopy in ruptured lung hydatid cysts

This study aims to evaluate the diagnostic yield of fiberoptic bronchoscopy in ruptured pulmonary hydatid cysts indistinguishable from pulmonary masses on imaging techniques.

Between January 2000 and January 2018, a total of 45 consecutive patients (27 males, 18 females; mean age 46.4±13.5 years; range, 23 to 78 years) who underwent fiberoptic bronchoscopy to establish the definitive diagnosis following radio-diagnostic procedures were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, preoperative diagnostic studies, bronchoscopic findings, and postoperative diagnosis were recorded.

Endobronchial hyperemia (n=42) and purulent secretion (n=34) are the most common findings of bronchoscopy. The most specific finding was the presence of pieces of cystic membranes in 23 patients. Scolices were seen in five patients in bronchial aspirate. In one patient, both pieces of cystic membranes and scolices in bronchial aspirate were detected. The preliminary diagnosis of a hydatid cyst was made based on these findings in 28 patients (62.2%) preoperatively. The definitive diagnosis of a hydatid cyst was confirmed through thoracotomy in all patients.

Bronchoscopy is a particularly valuable method in the definitive diagnosis of ruptured lung hydatid cysts. The definite diagnosis is based on the visualization of the endobronchial membrane during bronchoscopy or scolices in the bronchial aspirate. It can be also used to prevent complications such as bronchial dissemination and asphyxia due to intra-bronchial membrane pieces.