Pitfalls in the diagnosis of complicated pulmonary hydatid disease

The aim of this study was to present the pitfalls in the diagnosis of compl icated pulmonary hydatid disease and to discuss the unusual radiological pr esentations of this endemic disorder in Turkey. We retrospectively evaluated 34 patients (12 females) aged between 8 and 64 years, who were operated on at our centre between 1991 and 1998 and diagno sed with complicated pulmonary hydatid cyst histopathologically. Computeriz ed tomography (CT) scans of these patients were reviewed double-blind by tw o radiologists. The patients were then divided into two groups: group 1: in itial radiological impression is pulmonary hydatid cyst and group 2: initia l radiological impression is not pulmonary hydatid disease. These two group s were evaluated in terms of symptoms, radiographical presentation and labo ratory tests. The presence of cystic appearance, water-lily sign, ring enhancement concom itant with intact cysts unanimously led the radiologists to the diagnosis o f complicated pulmonary hydatid cyst, whereas solid appearance and presence of bronchial obliteration made the diagnosis unlikely. In such circumstanc es patient history, laboratory findings and bronchoscopic evaluation helped the diagnosis. In conclusion, in endemic regions like Turkey, atypical radiological presen tation of complicated pulmonary hydatid disease should be considered in the differential diagnosis of solid pulmonary lesions.