[Bronchoscopy in the diagnosis of complicated pulmonary hydatid cyst in children]

The diagnosis of pulmonary hydatid cysts in children is generally easy and does not require endoscopic exploration, because the radiological aspects of an intact or a complicated cyst are most often suggestive. There are, nevertheless, some cases of pulmonary hydatids where the cyst is partially evacuated and then infected, whose radiological image is atypical showing parenchymatous opacities (systematised or not) which are readily associated with adenopathy. Usually immunology fails to aid the clinician in this later stage in the cyst's evolution. Two recent cases are reported of Tunisian children aged 5 and 10 years old with chronic pulmonary opacities posing a diagnostic problem. One child presented with a persistent cough, the other with recurrent haemoptysis and both had negative immunology. Bronchoscopy enabled a positive diagnosis to be made in both cases by showing the presence of an intra-bronchial membrane. A simultaneous bronchogram showed an arrest of the contrast in the affected bronchial segment. Although non specific, this image of arrested contrast should in our opinion be discussed in the differential diagnosis when the membrane could not be seen at bronchoscopy. At operation surgery confirmed the retention of infected membrane but in our two children infection had led to the destruction of a lower lobe which was removed. These situations where the diagnosis of pulmonary hydatids is difficult are far from being rare in countries of hgh endemiology such as Tunisia. Our observations show the advantage of bronchoscopy, which sometimes enable one to see or to remove a fragment of the membrane and thus entrust the child to a surgeon with a definitive diagnosis.