Extrapulmonary intrathoracic hydatid cysts.
BACKGROUND
Hydatid disease, a clinical entity endemic in many sheep- and cattle-raising areas, is still an important health problem in the world. Extrapulmonary location of cysts in the thorax is rare. We report our experience with intrathoracic but extrapulmonary hydatid cysts and discuss concepts of treatment.


METHODS
In our Thoracic and Cardiovascular Surgery Department at the Dicle University School of Medicine, 133 patients with thoracic hydatid cysts were managed surgically between January 1990 and October 2002. In 14 (10.5%), the cysts were extrapulmonary but within the thorax, located in the pleural cavity, mediastinum, pericardium and diaphragm, or in pleural fissures. Cysts were intact in 12 patients and ruptured in 2. Radiographs of the chest were the main means of diagnosis; all patients with mediastinal and diaphragmatic cysts and some with pleural cysts were also scanned with computed tomography. All patients were managed surgically.


RESULTS
We operated on 3 mediastinal, 2 diapragmatic and 1 pericardial hydatid cyst, as well as 6 in pleural fissures and 2 in the pleural space. Lateral thoracotomy was chosen as the surgical incision in all patients except 1 (7% of the 14), who had median sternotomy for a pericardial hydatid cyst. Empyema developed in 2 patients (morbidity, 14%). No patient died perioperatively.


CONCLUSIONS
Hydatid cysts may be found in many different sites. Surgery to obtain a complete cure is the treatment of choice for most patients with intrathoracic but extrapulmonary cysts; excision must be done without delay to avoid or relieve compression of surrounding vital structures.
Ulkü
Refik
R
Thoracic and Cardiovascular Surgery Department, Dicle University School of Medicine, Diyarbakir, 21280 Turkey. refiku@dicle.edu.tr
Eren
Nesimi
N
Cakir
Omer
O
Balci
Akin
A
Onat
Serdar
S
D000293:Adolescent; D000328:Adult; D002648:Child; D004443:Echinococcosis / Q000175:diagnosis* / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013396:Suction; D013896:Thoracic Diseases / Q000175:diagnosis* / Q000469:parasitology / Q000601:surgery*; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome