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Canadian Respiratory Journal
Volume 18, Issue 5, Pages 258-260
http://dx.doi.org/10.1155/2011/197642
Case Report

Cystic Echinococcosis: Late Rupture and Complication of a Stable Pulmonary Cyst

J Fisher,1 Y Shargall,2,3 S Krajden,4 F Moid,5 and V Hoffstein3

1Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
2Department of Surgery, St Joseph’s Hospital, Canada
3Department of Medicine, St Michael’s Hospital, University of Toronto, Canada
4Department of Medicine, St Joseph’s Hospital, Toronto, Ontario, Canada
5Department of Pathology, St Joseph’s Hospital, Toronto, Ontario, Canada

Copyright © 2011 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.