title: Cystic echinococcosis: late rupture and complication of a stable pulmonary cyst.
abstract: Cystic echinococcosis is observed worldwide. Traditional management includes an invasive surgical approach with adjunctive chemotherapy. It has been suggested that observation alone may be appropriate in asymptomatic individuals with stable cysts. A case involving a 38-year-old Peruvian man with an asymptomatic bronchogenic cyst (suspected to be due to echinococcus, but never definitely diagnosed) is presented. The cyst was first noted in 1998, and was followed for 10 years during which time he remained asymptomatic with minimal radiographic change. One year later, in 2009, he presented with acute rupture of the cyst causing empyema. The patient required thoracotomy, decortication and resection of the ruptured cyst. Final pathology showed Echinococcus organisms. The patient responded well to treatment with albendazole and praziquantel, and became completely asymptomatic within six months. The present case demonstrates that echinococcal cysts may be at risk of spontaneous rupture, even after many years of clinical stability, thus supporting the case for resection of asymptomatic cysts suspected of being echinococcal at the time of diagnosis. In addition, the case illustrates that medical therapy with albendazole and praziquantel, in conjunction with surgical drainage, can be successful in the treatment of echinococcal empyema.
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, Manitoba.
authors.forename: J
authors.initials: J
authors.lastname: Fisher
authors.forename: Y
authors.initials: Y
authors.lastname: Shargall
authors.forename: S
authors.initials: S
authors.lastname: Krajden
authors.forename: F
authors.initials: F
authors.lastname: Moid
authors.forename: V
authors.initials: V
authors.lastname: Hoffstein
mesh_terms: D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000871:Anthelmintics / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage; D004359:Drug Therapy, Combination; D004445:Echinococcosis, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D011223:Praziquantel / Q000627:therapeutic use; D012422:Rupture, Spontaneous; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000871:Anthelmintics; D011223:Praziquantel; D015766:Albendazole