The lung is the second most common site (18 –35%) [1,2 ].The incidence of concomitant liver and lung hydatidosis varies from 5.8 –13.3 % [3, 4 ]. Most CE cases are diagnosed by a combination of clinical findings, medical imaging and serological tests. In 1996 we have introduced the wall sign (WS) as an ultrasound feature of CE, which has proven to be pathognomonic [5,6,7,8,9]
Because of the limited ultrasound access to the ventilated lung within the rib cage,reducing the visibility of intrapulmonary processes, pulmonary CE has always represented a challenge to ultrasound examinations. In this study, we have investigated suspected cases of pulmonary hydatid disease, utilizing the ultrasound WSC.
Discussion
Conventional chest radiography has been the diagnostic main stay in patients with CE of the lungs. Often coupled with serological tests; It is common for the diagnosis to be made from the microscopic discovery of hooklets in espiratory secretion, highlighting the value of close cooperation with microbiological staffs.Serologic tests including latex agglutination and specific IgE, IgM and IgG ELISA, are not standardised. IgG ELISA, however, has been shown to be the most sensitive test in pulmonary echinococcosis, with an 83% sensitivity [11]. IgG ELISA also seems to be useful for postoperative follow-up because persistently elevated antibody titres in the first year following surgery or a titre increase following a progressive decrease reliably indicates relapse or re-infection [11].
Bronchoscopy is indicated upon suspicion as it was shown to be useful in diagnosis of pulmonary hyadatid disease,and revealed pathological findings in 70%. CT scans are helpful in determining the exact anatomical location of the ulmonary cystic lesions, but there were no pathognomonic features for CE [12] on CT. Several conditions, such as bronchogenic carcinomas, benign tumours,inflammatory cystic masses,metastasis,and solid or fluid-filled cysts may mimic echinococcal cysts and make a definitive diagnosis difficult, even when using a multimodality imaging approach.Therefore, any hyperdense mass displayed on plain x-ray may represent a diagnostic pitfall regarding CE.
Following meticulous observation of the ultrasound scan of CE in different anatomical locations,we introduced the WS [5 –10].In this study, the WS was clearly displayed in all multivesicular cysts, because the cystic fluid filling the daughter cysts functions as a good acoustic window and makes it easier to see the adjacent walls. Interestingly, CT scan failed to identify any cystic lesion in 9 cases because of massive pleural effusion in which the cysts were immersed, while, for exactly the same reason (acoustic window), ultrasound examination of the same patients demonstrated the cysts very clearly. The diagnostic uncertainty of ultrasound in some cysts of the unilocular type can be attributed to multiple factors, such as continuing respiratory movement and deeply seated cysts where aerated lung tissue acts as a barrier for the ultrasound beam.
Our studies; conducted on pulmonary echinococcosis supports the search for the WS in pulmonary CE and shows that ultrasound greatly facilitates clinical decision making. In addition, the application of the WS in conjunction with plain x-ray may reduce the need for CT, which is not available in all hospitals. CT scan, however, is useful for determining the exact anatomical position of the cyst, even without using CT contrast agents.
References
1 Shields TW.General Thoracic Surgery.Willams &Wilkins,1994; Fourth Edition;Volume II:1021 –1027
2 Safioleas M,Misiakos EP,Dosios T et al.Surgical treatment for lung hydatid disease.World J Surg 1999;23:1181 –1185
3 Saidi F.Surgery of hydatid disease.WB Saunders,Philadelphia 1976; 3:31 –155
4 Kidess EA,Akiel AS,Ba ’aqeel HS et al.Echinoccosis:an obstetric and gynecologic view.Ann Saudi Med 1988;8:202 –207
5- El Fortia M,Bendaoud M,Shaban A et al.Noveau critere pour l ’identification du kyste hydatique non-complique,le signe de la paroi.J Echgr Med 1996;17:30 –35
6- El Fortia M, Bendaoud M, Badi H et al. Giant Hydronephrosis Mimicking Echinococcal Cyst. Ultraschall in Med in press
7- El Fortia M,Bendaoud M,Maghur H et al.Intracavitary cardiac hydatid cyst and the wall sign criteria.European Journal of Ultrasound 1998; 8:115 –117
8- El Fortia M,Bendaoud M,Yhia A.Subcutaneous extension of a large Echinococcal cyst.Eur Radiolo 2000;10:870
9- El Fortia M,Bendaoud M,Eldurrega S.Primary uterine hydatid cyst and the wall sign criteria.Ultrasound in obstetric and gynecology 1999; 13:374
10- El Fortia M, Elhajaji E, Elmadani B et al. Are they Spherules of Ovarian Cystic Teratoma or Daughter Cysts of
11- Zarzosa M P, Orduna Domingo A, Gutierrez P et al. Evaluation of six serological tests in diagnosis and postoperative control of pulmonary hydatid disease patients. Diagn Microbiol Infect Dis 1999;35 (4):255 – 262
12- Zapatero J, Madrigal L, Lago J et al. Surgical treatment of thoracic hydatidosis:a review of 100 cases.Eur J Cardiothorac Surg 1989; 3:436 – 440 1986;10:226 –232
Because of the limited ultrasound access to the ventilated lung within the rib cage,reducing the visibility of intrapulmonary processes, pulmonary CE has always represented a challenge to ultrasound examinations. In this study, we have investigated suspected cases of pulmonary hydatid disease, utilizing the ultrasound WSC.
Discussion
Conventional chest radiography has been the diagnostic main stay in patients with CE of the lungs. Often coupled with serological tests; It is common for the diagnosis to be made from the microscopic discovery of hooklets in espiratory secretion, highlighting the value of close cooperation with microbiological staffs.Serologic tests including latex agglutination and specific IgE, IgM and IgG ELISA, are not standardised. IgG ELISA, however, has been shown to be the most sensitive test in pulmonary echinococcosis, with an 83% sensitivity [11]. IgG ELISA also seems to be useful for postoperative follow-up because persistently elevated antibody titres in the first year following surgery or a titre increase following a progressive decrease reliably indicates relapse or re-infection [11].
Bronchoscopy is indicated upon suspicion as it was shown to be useful in diagnosis of pulmonary hyadatid disease,and revealed pathological findings in 70%. CT scans are helpful in determining the exact anatomical location of the ulmonary cystic lesions, but there were no pathognomonic features for CE [12] on CT. Several conditions, such as bronchogenic carcinomas, benign tumours,inflammatory cystic masses,metastasis,and solid or fluid-filled cysts may mimic echinococcal cysts and make a definitive diagnosis difficult, even when using a multimodality imaging approach.Therefore, any hyperdense mass displayed on plain x-ray may represent a diagnostic pitfall regarding CE.
Following meticulous observation of the ultrasound scan of CE in different anatomical locations,we introduced the WS [5 –10].In this study, the WS was clearly displayed in all multivesicular cysts, because the cystic fluid filling the daughter cysts functions as a good acoustic window and makes it easier to see the adjacent walls. Interestingly, CT scan failed to identify any cystic lesion in 9 cases because of massive pleural effusion in which the cysts were immersed, while, for exactly the same reason (acoustic window), ultrasound examination of the same patients demonstrated the cysts very clearly. The diagnostic uncertainty of ultrasound in some cysts of the unilocular type can be attributed to multiple factors, such as continuing respiratory movement and deeply seated cysts where aerated lung tissue acts as a barrier for the ultrasound beam.
Our studies; conducted on pulmonary echinococcosis supports the search for the WS in pulmonary CE and shows that ultrasound greatly facilitates clinical decision making. In addition, the application of the WS in conjunction with plain x-ray may reduce the need for CT, which is not available in all hospitals. CT scan, however, is useful for determining the exact anatomical position of the cyst, even without using CT contrast agents.
References
1 Shields TW.General Thoracic Surgery.Willams &Wilkins,1994; Fourth Edition;Volume II:1021 –1027
2 Safioleas M,Misiakos EP,Dosios T et al.Surgical treatment for lung hydatid disease.World J Surg 1999;23:1181 –1185
3 Saidi F.Surgery of hydatid disease.WB Saunders,Philadelphia 1976; 3:31 –155
4 Kidess EA,Akiel AS,Ba ’aqeel HS et al.Echinoccosis:an obstetric and gynecologic view.Ann Saudi Med 1988;8:202 –207
5- El Fortia M,Bendaoud M,Shaban A et al.Noveau critere pour l ’identification du kyste hydatique non-complique,le signe de la paroi.J Echgr Med 1996;17:30 –35
6- El Fortia M, Bendaoud M, Badi H et al. Giant Hydronephrosis Mimicking Echinococcal Cyst. Ultraschall in Med in press
7- El Fortia M,Bendaoud M,Maghur H et al.Intracavitary cardiac hydatid cyst and the wall sign criteria.European Journal of Ultrasound 1998; 8:115 –117
8- El Fortia M,Bendaoud M,Yhia A.Subcutaneous extension of a large Echinococcal cyst.Eur Radiolo 2000;10:870
9- El Fortia M,Bendaoud M,Eldurrega S.Primary uterine hydatid cyst and the wall sign criteria.Ultrasound in obstetric and gynecology 1999; 13:374
10- El Fortia M, Elhajaji E, Elmadani B et al. Are they Spherules of Ovarian Cystic Teratoma or Daughter Cysts of
11- Zarzosa M P, Orduna Domingo A, Gutierrez P et al. Evaluation of six serological tests in diagnosis and postoperative control of pulmonary hydatid disease patients. Diagn Microbiol Infect Dis 1999;35 (4):255 – 262
12- Zapatero J, Madrigal L, Lago J et al. Surgical treatment of thoracic hydatidosis:a review of 100 cases.Eur J Cardiothorac Surg 1989; 3:436 – 440 1986;10:226 –232
0 comments:
Post a Comment