Management of complicated giant thoracic hydatid disease

Background: Hydatid disease is a parasitic infestation frequently seen in sheep- and cattle-raising areas of the world, and has been known since the time of Galen and Hippocrates. We retrospectively evaluated patients who underwent surgery in our department due to complicated giant intrathoracic hydatid cysts. Material/Methods: Twenty patients with complicated giant intrathoracic hydatid cysts were operated on between May 2001 and May 2007 in our department. There were 14 male and 6 female patients, with an age range from 10 to 47 years (mean 23.7 +/- 11.2 years). Results: The most common symptoms were cough, chest pain, fever, and dyspnea. The most common physical finding was decreased breathing sounds at the affected hemi-thorax. There were signs of cyst perforation of the bronchial space in 14 patients. The cysts were ruptured to the pleural space in 5 patients, with pleural effusion or localized empyema; 4 of them required decortication due to air trapping in the lung. The cyst was found to be intact but infected in 1 patient with cardiac cyst. Cystotomy plus capitonnage was the most frequently used surgical procedure, which was performed in 18 patients, while lobectomy was performed in 1 patient, and left ventriculotomy plus cystotomy plus capitonnage was performed in 1 patient. Conclusions: All thoracic hydatid cysts should be operated on as soon as they are diagnosed in order to avoid complications, and surgery should be as conservative as possible. Since preoperative medical therapy can lead to perforation, additional adjuvant medical therapy should only be administered postoperatively to avoid recurrences.