[Management of massive hemoptysis secondary to pulmonary hydatidosis: Special features]

Massive hemoptysis is a rare but serious presentation of pulmonary hydatid cysts. The literature reporting this clinical phenomenon is limited to sporadic cases.

We undertook a retrospective study considering patients who had undergone lung surgery because of hydatid cyst from January 2000 o December 2015 and examined features associated with massive hemoptysis.

Among 270 patients operated on for lung hydatidosis, 13 (4.8%) had experienced massive hemoptysis. This sub group had an average age of 24±12 years (13-60 years) and a sex ratio of 0.85. Preoperative embolization was attempted in 5 patients but failed in all cases. All patients with massive hemoptysis were operated on emergency. The origin of bleeding was determined and controlled in all cases (from a vein or an artery from the pulmonary circulation). Pulmonary re-expansion was satisfactory after obliteration of the residual cavity and no pulmonary resection was necessary. The postoperative course was uneventful in 11 patients. Prolonged air-leak beyond 7 days was noted in two patients but settled subsequently with simple follow-up. Average postoperative follow-up was 32 months (8-63 months). One patient (who had hydatid vomit with massive hemoptysis) developed controlateral hydatid recurrence that was also successfully operated on. No recurrence of hemoptysis was noted during the follow-up period for all patients.

Massive haemoptysis secondary to pulmonary hydatidosis may be life-threatening. Surgery of hydatid cysts associated with direct vascular control of eroded vessels is sufficient to control hemoptysis.