Pulmonary Hydatidosis in Children: A Different Pattern from Adults?
Nesrine Chebil, Sondes Sahli, Fatma Fitouri, Senda Houidi, Arij Zouaoui, Yasmine Houas, Yosra Kerkeni, and Riadh Jouin
Department of Pediatric Surgery A, University of Tunis El Manar, Tunis, Tunisia
Correspondences to: Dr. Nesrine Chebil. Email: firstname.lastname@example.org
Received: 05 Mar 2021; Revised: 07 Sep 2021; Accepted: 15 Sep 2021; Available online: 27 Nov 2021
Background: Hydatidosis is a major health problem is many countries. It is a parasitic disease that can affect adults as well as children. Hydatid cyst often involves the lungs in children. Given the anatomical and physiological differences between children and adults, generalization from adult studies is inappropriate. Methods: To determine particularities of lung echinococcosis in children, we conducted a retrospective study of all cases treated for hydatid cyst of the lung at our department. Results: One hundred fifteen children (average age, 7 years 6 months; range, 3–15 years) were managed for pulmonary hydatid cyst, which corresponds to 66% of all hydatid localizations. Male predominance was noted (sex ratio=1.94). Cough (60.9%) and chest pain (59.1%) were the most common clinical features. Fever and fatigue were noted in 57 (49.5%) and 34 (29.5%) cases, respectively. Giant cysts were seen in 11 patients (10%). The cysts were mostly diagnosed when they are intact (68.7%). Mixed hepatic and pulmonary cysts were noted in 27 cases (4.25%). Conservative muscle-sparing surgery was performed in all cases. Complications were noted in 20% of the cases. Conclusion: As hydatidosis has a different pattern in children, optimal management requires a better knowledge of its particularities in this age group.
Keywords: Hydatid cyst, Lung, Particularities, Children
Ann Afr Surg. 2022; 19(1): 23-27
Conflict of interest: None
© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Hydatid disease is known as echinococcosis or hydatidosis, and the causative microorganism is usually a tapeworm parasite called Echinococcus granulosus (1). This zoonosis is endemic to many sheep- and cattle-rearing regions of the world, particularly in the Mediterranean countries, including Tunisia, where it continues to represent a major health problem (2). Humans are accidental hosts by eating tapeworm eggs (1). It commonly starts during childhood or adolescence (3). In children, the lung is the most common site of localization of the larval form, which is the cyst (4). This can be explained by the higher patency of the hepatic filter (first filter) in children, thus permitting the parasite to reach the lungs (second filter) (5). There are certain unique characteristics of the pediatric hydatid cyst (6).We aimed to review the particularities of the clinical presentations, diagnosis, surgical treatment, and post-operative outcomes of pulmonary hydatid cysts in children.
Materials and Methods
This retrospective cross-sectional study was performed of all cases diagnosed and treated for hydatid cyst of the lung at the Department of Pediatric Surgery of our institution. It was carried out from January 1, 2005, to December 31, 2018. Data recorded included patients’ demographics, symptoms, imaging and laboratory findings, intraoperative data, complications, and recurrence. Ethical approval was obtained from the head of the Department of Pediatric Surgery and from the ethics committee of our institution (Approval ref. number 2021-16).
One hundred fifteen children were managed for pulmonary hydatid cyst, which corresponds to 66% of all hydatid localizations. A male predominance was noted (sex ratio=1.94). The average age was 7 years and 6 months and ranged from 3 to 15 years. The most affected age group was 7–10 years. In our study, 86.1% of the children resided in a rural area, and their families were involved in animal husbandry. Cough and chest pain were the chief complaints in 60.9% and 59.1% of the cases, respectively. The other clinical features were hemoptysis (20% of the cases), vomiting (17.4% of the cases), and dyspnea (19% of the cases). Fever and fatigue were noted in 57 (49.5%) and 34 (29.5%) of the cases, respectively. The hydatid cyst was fortuitously discovered on a chest X-ray in 5.2% of the cases. Physical examination was normal in 17.4%. Otherwise, it was non-specific. Pulmonary examination found ronchi in 7.8% of the patients and dullness at percussion in 11.3%. A homogeneous hepatomegaly reflecting a hydatid cyst of the liver was found in 7.8 %. Plain chest roentgenogram was sufficient to confirm the diagnosis of pulmonary hydatidosis in 78.2% of the cases, whereas in other patients (21.8%), chest ultrasonography and computed tomography were needed. A unique cyst was noted in 86% of the cases. The lesions were unilateral in 92.2% of the cases and right-sided in 48.7% of the cases. Cysts were located preferentially in the lower lobs (56.5%), with no statistical significance (Table 1). Ten percent of the patients with giant cyst had a median age of 12 years (Figure 1) (Table 2). The cysts were complicated in 31.3% of the cases. Chest computed tomography (Figure 2) and chest ultrasound were performed in 31 patients.
Click to view table 1: Table 1, Localization of cysts
Click to view Figure 1: Figure 1, Pre-treatment chest radiogram showing a giant cyst of the right lung (arrow).
Click to view Table 2: Table 2, Size of cysts
Click to view Figure 2: Figure 2, Thoracic computed tomography scan showing an intact hydatid cyst (marked with a star) of the left lung: axial (A) and coronal (B) sections
Magnetic resonance imaging (MRI) was not performed. An intra-abdominal localization was detected with a systematic ultrasonography in 29 patients