Chest wall hydatid cyst: an unusual localization

Abstract

Introduction: Hydatid disease is still endemic in several countries. Hepatic and pulmonary localizations are the most frequent. The chest wall localization is rare and represents less than 3.5%. Diagnostic and management may represent real challenge

Methods: Retrospective study, over 30 years, of cases of chest wall hydatid cysts treated by surgical resection

Results: There were 8 women and 5 men. The mean age was 28 years. Four patients had previous surgery for lungor hepatic hydatidosis. The chest wall was the primary site in 3 patients. Symptoms were mainly thoracic pain(7 cases),cough(4 cases),dyspnea(4 cases),hemoptysis(3 cases),swelling chest wall(3 cases),spinal compression syndrome(3 cases) and fistulation to skin(1 case).Computed tomographic scan was performedin all cases. The median size of the cyst was 65 mm(20-120 mm).The hydatid cysts were located on paravertebral muscles(6 cases),ribs(5 cases),spine(4 cases),parietal pleura(4 cases) and breast(1 case).Ten patients had also pulmonary or hepatic hydatidosis. Posterolateral thoracotomy was used in 7 cases, electif approach in 6 cases, median sternotomie in 1 case, lateral thoracotomy in 1 case and thoraco-phreno-laparotomy in 1 case. Three patients have had double approach. The cyst is totally excised with pericystic tissues in all cases. The involved rib was resected in 4 cases. The involved vertebrae were partially resected in 4cases. The chest wall defect was reconstructed by using Mersilenemesh in 1 case. The postoperative course was complicated in 1 case(prolonged air leaks)

Conclusion: Hydatid cyst can involve all the thoracic structures. Chest wall localization is rare. This rarity may cause difficulties in diagnosis. To avoid recurrence, it is necessary to resect the affected tissues completely