Abstract
A 10 year old girl from Irak was routinely screened for tuberculosis after immigration. She reported chronic cough and chest pain during the past year. A cystic lesion was detected on chest X-ray, and confirmed by a chest CT which also showed some pleural nodules. There was no suspicion of malignancy, tuberculosis was excluded and Echinococcus serology was negative. Bronchoscopy showed no abnormalities, BAL cultures were negative and galactomannan was normal. Abdominal ultrasound excluded cystic lesions in the liver. She was treated with antibiotics and her symptoms dissapeared. Surgery was scheduled to make a final diagnosis and because of the infection risk, with a diagnosis of infected CCAM and pleural adhesions. Before surgery we made an MRI scan which revealed a massive amount of cystic lesions, occupying a large part of her left hemithorax. We now suspected dissiminated thoracic echinococcosus, and repeated serology, wich was now positive. After albendazole pretreatment a left lower lobectomy and resection of a large number of cysts was performed. Retrospectively, she had experienced an episode where she had noticed a salty taste and had expectorated white matter, presumable as a sign of endobronchial rupture of an ecchynococcus cyst. In conclusion, we present a rare case of extensively dissiminated pulmonary and thoracic ecchinococcosus, which might have been prevented by careful medical history taking, which could have detected cyst rupture.
- © 2011 ERS
