Chest wall hydatidosis: a case series of 26 patients

Abstract

Background: Hydatid cyst is an endemic disease that is common in the Mediterranean countries .Extra pulmonary intrathoracic localization of the cysts such as thoracic wall involving ribs, muscles, and vertebrae is very rare

Methods: We retrospectively reviewed the records of 26 patients managed between 2000 and 2020 in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana – Tunisia.

Results: There were 9 woman and 17 men, with a mean age of 41 years (18-76).The most common signs were chest pain (12 cases), neurological deficit (5 cases) ,cough and dyspnea (3 cases). Parietal swelling was reported in 10 cases and 1 patient was asymptomatic. Chest X-ray showed an homogeneous opacity (6 cases), bone destruction (4 cases) and was normal in 5 cases. The cysts mostly were located at ribs (16 cases) and ribs with vertebrae (13 cases). Other parts of chest wall were involved like muscles and sub-cutaneous tissue in 1 case in the sternum in 2 cases. CT scan and MRI often revealed the diagnosis .The cyst was mimicking tumor in 1 case.15 patients underwent costal resection; 7 underwent a costovertebral resection. Other surgical procedures were partial resection of the sternum (two cases) and cystectomy with resection of parietal soft tissue (2 cases).the postoperative course was uneventful in 22 cases .reported complications were paraplegia in 1 case , ARDS and death in 1 case and severe sepsis in 2 cases. Albendazole was given for most cases.

Conclusion: Current imaging investigations make diagnosis of chest wall hydatidosis easier. Radical surgery combined with antihelminthic therapy is the best treatment. Prevention is necessary.