Images in Clinical Medicine
Thoracic Echinococcosis
N Engl J Med 2003; 348:528February 6, 2003
- Article
A 32-year-old Kenyan woman presented in Boston with a three-month history of cough that was initially productive of thick, gray sputum that had gradually become blood-tinged. She had low-grade fevers. Chest radiography revealed an apparent elevation of the right hemidiaphragm (Panel A). Computed tomography of the chest with contrast medium revealed a low-density cystic mass measuring 13 by 13 by 10 cm in the right lower hemithorax, with a thick, irregular wall (coronal reconstruction, Panel B). The cyst did not cross the diaphragm. Ultrasound-guided aspiration of the contents of the cyst yielded clear, colorless fluid. Hydatid sand containing a protoscolex of Echinococcus granulosus was seen on microscopical examination (unstained wet preparation, ×40; Panel C). The protoscolex is evaginated; two hooklets (arrow) remain attached (inset). Hooklets are resistant to degradation and may be the only microscopical clue to the diagnosis when the contents of the cyst are examined. Three days later, cystectomy was performed, with the use of specific precautions to prevent local spread of disease. After adequate antiparasitic treatment, follow-up radiography demonstrated reexpansion of the right lung. The patient has returned to her normal level of activity, and there is no evidence of recurrent disease.
Diana M. Brainard, M.D.
Edward T. Ryan, M.D., D.T.M.&H.
Massachusetts General Hospital, Boston, MA 02114- Citing Articles (2)
Citing Articles
1
Sevket Kavukcu, Dalokay Kilic, Arif Osman Tokat, Hakan Kutlay, Ayten Kayi Cangir, Serkan Enon, Ilker Okten, Nezih Ozdemir, Adem Gungor, Murat Akal, Hadi Akay. (2006) Parenchyma-Preserving Surgery in the Management of Pulmonary Hydatid Cysts. Journal of Investigative Surgery 19:1, 61-68
CrossRef2
(2003) Thoracic Echinococcosis. New England Journal of Medicine 348:21, 2156-2157
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