Rupture of pulmonary hydatid cyst in pediatrics: A cross-sectional study

Pulmonary hydatid cyst is a parasitic disease causing an endemic and a health burden in many regions. Lung cysts are more common than liver cysts in children and patients may remain asymptomatic. Cyst rupturing is not uncommon, and it is considered the most feared complication. In this cohort study, we aimed to identify the risk factors related to cyst rupture in a Jordanian pediatric population.

We retrospectively evaluated all pediatric patients who underwent cystostomy and capitonnage for pulmonary hydatid cyst between 2003 and 2020 at King Abdullah University Hospital.

We found 43 patients with a mean age of 13 ± 4 years who suffered from 61 pulmonary cysts. 55.6% of them were males. The most prevalent symptom was shortness of breath. The rupture rate for patients was 39.5%, and 29.5% for cysts. None of the patients with cyst rupture had an anaphylactic reaction. The left lower lobe was the most common location for both intact and ruptured cysts. 25.6% of the patients had giant cysts (>10 cm) with a mean of 7.4 cm for all cysts. Patients with intact cysts had higher-rates of cough (42.3% vs. 29.4%) and lower-rates of shortness of breath (34.6% vs. 52.9%) than patients with ruptured cysts, which were not statistically significant. Although statistically insignificant, patients with ruptured cysts tended to have multiple cysts in one lung (29.4% vs. 7.7%, p = 0.180), and more complication rates (29.4% vs 7.7%, p = 0.09). Both groups had almost identical IgG-ELISA positive results. We found no significant association between cyst rupture and age, gender, presenting symptoms, cyst size, cyst location, and rate of postoperative complications.

The rupture of pulmonary hydatid cyst has clinical consequences in pediatric patients, further studies on larger populations are needed to identify factors that make patients more prone to rupture and prioritize them for clinical monitoring and management.