Hydatid disease of the liver with thoracic involvement

Hydatidosis, caused by Echinococcus granulosus, is an endemic parasitic dis ease in Mediterranean countries. The most frequent anatomic locations are l iver and lung. Intrathoracic rupture of hydatid cysts situated in the hepat ic dome is a serious complication resulting in damage to the pleura, pulmon ary parenchyma, and bronchi. From January 1984 to December 1997 we operated on 40 patients with intrathoracic rupture of a hepatic hydatid cyst. Chest roentgenograms showed a shadow of varying size at the base of the hemithor ax. Hepatic and thoracic ultrasonography was performed in all cases. The di agnosis of intrathoracic rupture of a liver cyst was confirmed preoperative ly in 30 of the 40 cases. Posterolateral thoracotomy was performed in all p atients. This transthoracic approach allowed adhesiolysis and treatment of the pleural lesions, pulmonary lesions, and hepatic cyst. Treatment of the diaphragmatic gap is easily done. We performed lj lobectomies, 10 wedge res ections, 16 decortications, and in one patient simple drainage of a volumin ous pleuropulmonary and hepatic purulent hydatic collection. The postoperat ive course was uneventful in 26 cases, but 14 patients had complications, f rom which 3 patients died. The therapeutic approach depends on ultrasonogra phic findings. We believe ultrasonography to be the best examination for as sessing biliary, hepatic, diaphragmatic, and pleuropulmonary lesions. When an intrathoracic collection is present, thoracotomy must be performed and i s sufficient if the biliary tract is safe. An abdominal approach is necessa ry when biliary duct drainage is required, and it may be sufficient in cast s of direct rupture into the bronchi.