MANAGEMENT OF PULMONARY

HYDATID DISEASEProf. Abdulsa lam Y Taha

School of Medic ineUnivers i ty of Su la imani

I raq

https://sulaimaniu.academia.edu/AbdulsalamTaha

PHC

• LIFE CYCLE.• CYST STRUCTURE.• PLAIN CXR AND CT SCAN.• BRONCHOSCOPY.• PRINCIPLES OF SURGERY.• SELECTIVE CASES.

LIFE CYCLE

STRUCTURE OF CYST

LAMINATED MEMBRANE

PLAIN CXR

PLAIN CXR: THE INTACT CYST

CXR: BILATERAL CYSTS

CT SCAN: INTACT CYST

CT SCAN: MULTIPLE INTACT CYSTS

PERIVESICULAR PNEUMOCYST

THE WATER-LILY SIGN

CAVITARORY LESION

CT SCAN: INTRA-BRONCHIAL RUPTURE

CT SCAN: THE CENTRAL CYST

ATYPICAL RADIOLOGICAL DENSITIES

ATYPICAL RADIOLOGRAPHIC DENSITY

ELEVATED DIAPHRAGM

THE INTRA-PLEURAL RUPTURE

PULMONARY ANGIOGRAPHY

RADIOGRAPHIC SIMULATORS

LOCALIZED BENIGN MESOTHELIOMA

LOCALIZED MALIGNANT MESOTHELIOMA

NEUROFIBROMA

NEUROBLASTOMA

FIBEROPTIC BRONCHOSCOPY

PRINCIPLES OF SURGERY

• Removal of cyst contents.• Avoidance of soiling of operative field.• Preservation of as much lung tissue as

possible.• Closure of bronchiolar fistulae.• Management of residual cystic cavity.• Achievement of early and complete lung

expansion.

ANESTHETIC TECHNIQUES

• SINGLE OR DOUBLE LUMEN ET TUBES?• FREQUENT SUCTION VIA ET TUBE.• PROTECTION AGAINST ANAPHYLAXIS.• SYNCHRONIZED INFLATION AND

DEFLATION OF THE LUNG WITH SURGICAL PROCEDURE.

REMOVAL OF CYST

• ENUCLEATION.• INJECTION, ASPIRATION AND

EVACUATION.• ASPIRATION AND EVACUATION.• EXCISION OF CYST.

ENUCLEATION OF CYST

INJECTION, ASPIRATION & EVACUATION

ASPIRATION AND EVACUATION

SCOLICIDAL AGENTS

• POVIDONE IODINE.• 10% HYPERTONIC SALINE.• HYPERTONIC GLUCOSE.• 10% FORMALDEHYDE.• NONE IS AN IDEAL SCOLISIDAL AGENT.• THE BEST IS ( CONTROLLED EVACUATION OF

CYST CONTENTS).

WHEN TO RESECT?

• HUGE SIMPLE HC CAUSING LOBE DESTRUCTION.

• SEVERELY SUPPURATED RUPTURED CYST.• MULTIPLE DAUGHTER CYSTS IN MOTHER CYST.• LIFE-THREATENING HEMOPTYSIS.• BROCHO-BILIARY FISTULA.• HYDATID BRONCHIECTASIS.

HUGE INTACT PHC IN LUL IN AN 8 YR OLD BOY MANAGED BY LOBECTOMY

TRANS-THORACIC TRANS-DIAPHRAGMATIC

REMOVAL OF LIVERHYDATID CYSTS

CXR

CT SCAN

R THORACOTOMY

R THORACOTOMY

THE OPERATION

POSTOP CXR

MORBIDITY

• PROLONGED AIR LEAK.• EMPYAEMA.• PNEUMONIA DUE TO ASPIRATION OF CYTIC

CONTENTS OR WASHING SOLUTIONS.

MORTALITY* UNRECOGNIZED CNS OR PULMONARY

ARTERY CYSTS.

TAKE HOME MESSAGES

• PHD IS ENDEMIC IN OUR COUNTRY.

• CXR IS THE CHIEF DIAGNOSTIC MODALITY.

• CONSIDER DIFFERENTIAL DIAGNOSES.

• PREVENTION IS ACHIEVABLE.

• SURGERY IS STILL THE MAIN TREATMENT.

• ALWAYS TRY TO PRESERVE LUNG TISSUE.

• LUNG RESECTION IS DONE SPORADICALLY FOR CERTAIN INDICATIONS.

• SEARCH FOR CNS AND PA CYSTS IN PATIENTS WITH DISSEMINATED HYDATIDOSIS.

THANK YOU FOR YOUR ATTENTION!