eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
Current issue Archive Manuscripts accepted About the journal Supplements Editorial board Reviewers Abstracting and indexing Contact Instructions for authors Publication charge Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
4/2014
vol. 11
 
Share:
Share:

CASE REPORT
Fistulization of hydatid mediastinal cyst to the anterior thoracic wall: case report

Serpil Sevinc
,
Ozgur Samancıiar
,
Taner Ozturk
,
Saban Unsal
,
Seyda Ors Kaya

Kardiochirurgia i Torakochirurgia Polska 2014; 11 (4): 425-427
Online publish date: 2014/11/30
Article file
- 13_Sevinc.pdf  [0.38 MB]
Get citation
 
PlumX metrics:
 

Introduction

There are four different sub-types of hydatid disease. The most frequently seen are Echinococcus granulosus and E. multilocularis, leading to alveolar echinococcosis. Mediastinal disease is very rare [1]. Intrathoracic extrapulmonary disease is generally located in the mediastinum, pleura, pericardium and the thoracic wall [2]. The incidence of the disease in Turkey was reported as 6.3/100 000 [3], while the incidence of mediastinal hydatid cyst is 0.1-0.5%. Most of them are located in the posterior mediastinal compartment (55%), whilst 36% are located in the anterior mediastinum [4]. The presented case is the first reported case of fistulization to the skin from mediastinal disease in the literature.

Case report

The 31-year-old man presented with swelling in the right subclavicular region. There was nothing pathological that could be detected on the chest X-ray. In computed thorax tomography scan, a multiloculated cystic lesion was seen, 5 cm x 3 cm in diameter, located in the anterior mediastinum, and a catheter was placed to observe the tract of the fistula (Fig. 1, 2). It was observed that a lucid fluid and white membrane particles were drained from the fistula. The result of histopathological examination of this material was reported as “hydatid cyst membrane”. Other physical examinations and laboratory findings were normal. Surgical intervention through a partial sternotomy was planned for the patient. In the surgical exploration, multiple cysts which had diameters of 2 mm to 2 cm were detected and extracted. The pericystic layer was excised. The operative field and the fistula were irrigated with hypertonic saline. The fistula tract under the sternocleidomastoid muscle from the anterior mediastinum was identified and curetted (Fig. 3, 4). The patient was discharged on the fourth postoperative day without any complications. Three courses of albendazole tablets with a dose of 10 mg/kg/day were applied postoperatively. Each course lasted for three weeks, and the next course was started after a 10-day break after checking the blood tests for screening of liver functions.

Discussion

Echinococcosis/hydatidosis is the most frequent parasitic and zoonotic disease in the population engaged in agriculture and stockbreeding. It is endemic in the Mediterranean countries such as Turkey. Mediastinal location of hydatid cysts is extremely rare [1]. Ulku et al. mentioned a total 14 cases (10.5%) in a series of 133 cases with intrathoracic extrapulmonary hydatid disease, and only three of them were at the anterior mediastinum [5].
Patients may be asymptomatic but symptoms can be present due to the pressure of the enlarged cyst on the surrounding organs [5]. Gursoy et al. reported that chest pain and dyspnea were present in 70% of cases of intrathoracic extrapulmonary hydatid cyst [6]. Since the mediastinal cystic lesion was ruptured and fistulization to the skin was present, swelling was the only symptom in our case. Bilio-bronchial fistula due to hydatid disease and aorto-bronchial fistula cases leading to massive hemoptysis was also reported in the literature [7, 8].
Ozyurtkan et al. reported two cases of anterior mediastinal cysts approached by thoracotomy [1]. We implemented fistula tract repair, multiple cystectomy via partial sternotomy and local curettage, which were successfully performed in our case. Eroglu et al. also reported four patients who had hydatid cysts in the anterior mediastinum. They approached three cases by sternotomy and one case by thoracotomy [9].
In conclusion, hydatid disease should be included in the differential diagnosis in patients with an anterior mediastinal cystic mass in places where the disease is endemic. Surgical treatment should be applied immediately for cysts located too close to the vital mediastinal organs to avoid perforation and contamination of the mediastinum.

Disclosure

Authors report no conflict of interest.

References

1. Özyurtkan MO, Koçyiğit S, Çakmak M, Ozsoy IE, Balci AE. Case report: mediastinal hydatid cysts. Türkiye Parazitol Derg 2009; 33: 179-181.
2. Oğuzkaya F, Akçalı Y, Kahraman Ç, Bilgin M, Şahin A. Unusually located hydatid cysts: intrathoracic but extrapulmonary. Ann Thorac Surg 1997; 64: 334-337.
3. Yazar S, Taylan Özkan A, Hökelek M, Polat E, Yılmaz H, Özbilge H, Üstün S, Koltas 9S, Ertek M, Sakru N, Alver O, Çetinkaya Z, Koç Z, Demirci M, Aktas H, Parsak CK, Özerdem D, Sakman G, Cengiz ZT, Özer A, Keklik K, Yemenici N, Turan M, Dastan A, Kaya E, Sönmez Tamer G, Girginkardesler N, Türk M, Sınırtas M, Evci C, Kılıçturgay S, Mutlu F, Artıs T. Türkiye’de 2001-2005 yılları arasında kistik ekinokokkozis. Türkiye Parazitol Derg 2008; 32: 208-220.
4. Thameur H, Chenik S, Abdelmoulah S, Bey M, Hachicha S, Chemingui M, Mestiri T, Chaouch H. Thoracic hydatidosis: a review of 1619 cases. Rev Pneumol Clin 2000; 56: 7-15.
5. Ulkü R, Eren N, Cakir O, Balci A, Onat S. Extrapulmonary intrathoracic hydatid cysts. Can J Surg 2004; 47: 95-98.
6. Gursoy S, Ucvet A, Tozum H, Erbaycu AE, Kul C, Basok Ol. Primary intrathoracic extrapulmonary hydatid cysts: analysis of 14 patients with a rare clinical entity. Tex Heart Inst J 2009; 36: 230-233.
7. Buchholz S, Sowden D, Stapleton T, Pohlner P, Wright C. Massive haemoptysis due to aortobronchial fistula caused by pulmonary hydatidosis. Med J Aust 2009; 190: 222.
8. Kabiri EH, Traibi A, Arsalane A. Bilio-bronchial fistula due to hydatic disease: case report and review of the literature. Rev Pneumol Clin 2011; 67: 380-383.
9. Eroğlu A, Kurkcuoğlu C, Karaoglanoglu N, Tekinbas C, Kaynar H, Onbas O. Primary hydatid cysts of the mediastinum. Eur J Cardiothorac Surg 2003; 23: 257-258.
Copyright: © 2014 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska). This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.