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Complicated hydatid cyst and "air bubble" sign: a stepping-stone to correct diagnosis.

Singh U, Kumar S, Gour H, Singh N, Ramaraj M, Mittal V, Jhim D - Am J Case Rep (2015)

Bottom Line: A 32-year-old female on anti-tubercular treatment for the past 3 months without any improvement was admitted to our hospital.After 15 days the patient had a vigorous bout of coughing, leading to expectoration of pieces of whitish yellowish gelatinous membrane for the next 3 days.The ELISA result for Echinococcus was highly positive.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India.

ABSTRACT

Background: Hydatid cyst, or Echinococcosis, is an important helminthic zoonotic disease in humans that commonly affects the liver and lungs. Uncomplicated hydatid cysts, seen as round opaque lesions on chest radiography, are easily diagnosed, whereas complicated cysts (infected and or perforated) may change the radiographic appearance of the hydatid cyst, causing an incorrect diagnosis and delayed treatment. Although in radiology many signs have been described, the "air bubble" sign, seen in the mediastinal window of CECT as a single or multiple small rounded radiolucent areas with sharp margins within the periphery of a solid mass lesion, is being recognized as a sign with high sensitivity and specificity in the diagnosis of complicated hydatid cysts.

Case report: A 32-year-old female on anti-tubercular treatment for the past 3 months without any improvement was admitted to our hospital. CECT of the chest revealed a mass-like lesion with the "air bubble" sign. After 15 days the patient had a vigorous bout of coughing, leading to expectoration of pieces of whitish yellowish gelatinous membrane for the next 3 days. The ELISA result for Echinococcus was highly positive. On the basis of the "air bubble" sign, positive serology, and expectorated pieces of the membrane, the patient was diagnosed as having a complicated hydatid cyst.

Conclusions: Due to the varied presentations of complicated hydatid cyst, the knowledge and awareness of various signs in radiology associated with the hydatid cyst, in particular the "air bubble" sign, is imperative in making a prompt and accurate diagnosis of a complicated hydatid cyst.

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Chest X-ray PA view showing a homogeneous opacity in the right upper zone.
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f1-amjcaserep-16-20: Chest X-ray PA view showing a homogeneous opacity in the right upper zone.

Mentions: A 32-year-old woman presented to our department with complaints of fever and cough with expectoration for the past 4 months. The fever was low-grade and intermittent, and the cough was accompanied with expectoration, was moderate in quantity and mucopurulent in character. Three months earlier, she had been put on anti-tubercular treatment on the basis of her lesions on X-ray (Figure 1), despite her sputum for AFB (Acid fast bacilli) being negative, in the form of category 1 DOTS (directly observed therapy short course) under RNTCP (Revised National Tuberculosis Control Programme) without any improvement. General physical examination showed a moderately built and nourished anemic female. She was febrile, alert, with a pulse rate of 92/min, respiratory rate of 22/min, and blood pressure of 110/76 mm Hg. Examination of all other organs were essentially normal. Examination of the respiratory system revealed impaired percussion note, decreased vesicular breath sounds, and vocal resonance over the right clavicular and supra scapular region. Her latest x-ray chest (Figure 2) showed no change in the opacity in the right upper zone as compared to her earlier x-ray. Other than a hemoglobin of 9.5% gm, her hematological and biochemical tests were non-revealing. Her sputum for AFB (acid-fast bacilli) and gram stain were negative. Her sputum, sent for culture for pyogenic organisms and BACTEC for AFB, showed no growth.


Complicated hydatid cyst and "air bubble" sign: a stepping-stone to correct diagnosis.

Singh U, Kumar S, Gour H, Singh N, Ramaraj M, Mittal V, Jhim D - Am J Case Rep (2015)

Chest X-ray PA view showing a homogeneous opacity in the right upper zone.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4307737&req=5

f1-amjcaserep-16-20: Chest X-ray PA view showing a homogeneous opacity in the right upper zone.
Mentions: A 32-year-old woman presented to our department with complaints of fever and cough with expectoration for the past 4 months. The fever was low-grade and intermittent, and the cough was accompanied with expectoration, was moderate in quantity and mucopurulent in character. Three months earlier, she had been put on anti-tubercular treatment on the basis of her lesions on X-ray (Figure 1), despite her sputum for AFB (Acid fast bacilli) being negative, in the form of category 1 DOTS (directly observed therapy short course) under RNTCP (Revised National Tuberculosis Control Programme) without any improvement. General physical examination showed a moderately built and nourished anemic female. She was febrile, alert, with a pulse rate of 92/min, respiratory rate of 22/min, and blood pressure of 110/76 mm Hg. Examination of all other organs were essentially normal. Examination of the respiratory system revealed impaired percussion note, decreased vesicular breath sounds, and vocal resonance over the right clavicular and supra scapular region. Her latest x-ray chest (Figure 2) showed no change in the opacity in the right upper zone as compared to her earlier x-ray. Other than a hemoglobin of 9.5% gm, her hematological and biochemical tests were non-revealing. Her sputum for AFB (acid-fast bacilli) and gram stain were negative. Her sputum, sent for culture for pyogenic organisms and BACTEC for AFB, showed no growth.

Bottom Line: A 32-year-old female on anti-tubercular treatment for the past 3 months without any improvement was admitted to our hospital.After 15 days the patient had a vigorous bout of coughing, leading to expectoration of pieces of whitish yellowish gelatinous membrane for the next 3 days.The ELISA result for Echinococcus was highly positive.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, Government Medical College, Patiala, Punjab, India.

ABSTRACT

Background: Hydatid cyst, or Echinococcosis, is an important helminthic zoonotic disease in humans that commonly affects the liver and lungs. Uncomplicated hydatid cysts, seen as round opaque lesions on chest radiography, are easily diagnosed, whereas complicated cysts (infected and or perforated) may change the radiographic appearance of the hydatid cyst, causing an incorrect diagnosis and delayed treatment. Although in radiology many signs have been described, the "air bubble" sign, seen in the mediastinal window of CECT as a single or multiple small rounded radiolucent areas with sharp margins within the periphery of a solid mass lesion, is being recognized as a sign with high sensitivity and specificity in the diagnosis of complicated hydatid cysts.

Case report: A 32-year-old female on anti-tubercular treatment for the past 3 months without any improvement was admitted to our hospital. CECT of the chest revealed a mass-like lesion with the "air bubble" sign. After 15 days the patient had a vigorous bout of coughing, leading to expectoration of pieces of whitish yellowish gelatinous membrane for the next 3 days. The ELISA result for Echinococcus was highly positive. On the basis of the "air bubble" sign, positive serology, and expectorated pieces of the membrane, the patient was diagnosed as having a complicated hydatid cyst.

Conclusions: Due to the varied presentations of complicated hydatid cyst, the knowledge and awareness of various signs in radiology associated with the hydatid cyst, in particular the "air bubble" sign, is imperative in making a prompt and accurate diagnosis of a complicated hydatid cyst.

Show MeSH
Related in: MedlinePlus