reportHepatopulmonary hydatidosis in a ten-year-old girl : a case report

Introduction: Hydatid disease is a parasitic infection caused by the tapeworm Echinococcus granulosus and is characterised by cystic lesions in the liver and lungs. Concomitant pulmonary and hepatic localization of hydatid cysts in childhood is unusual and represents a distinct clinical entity called hepatopulmonary hydatidosis. Case presentation: A ten-year-old Caucasian girl, a permanent resident of rural Greece, was admitted to hospital reporting a nonspecific symptomatology compatible with a diagnosis of viral infection. Chest radiography revealed a large homogenous circular opacity in the right lung field. On the basis of imaging studies, a diagnosis of hydatidosis was made with synchronous hepatic and pulmonary involvement, successfully managed through a single-stage transthoracic surgical approach. Conclusion: This case report highlights the necessity of realizing that hydatid disease continues to be a public health problem, which often remains asymptomatic for years. Therefore, the presence of any homogeneous cystic spherical opacity on routine chest radiography should raise the suspicion of hydatid disease, mainly in endemic areas such as Greece. General practitioners and physicians involved in pediatric care need to be familiar with the diagnosis and management of the variable clinical manifestations of hydatid disease. Taking into consideration that hepatopulmonary hydatidosis represents a special entity that requires a different therapeutic approach may positively affect its economic and social-related burden. Introduction Hydatid disease is caused by the tapeworm Echinococcus granulosus [1] and represents the most important parasitic infection in the Mediterranean region [2]. Greece, in particular, is a highly endemic area, partly because of the family character of occupation with animal husbandry observed in rural areas [2]. The liver is the most commonly affected organ (> 65%) followed by the lung (> 25%) [1], which is the predominant site of cyst formation in children. We report a case with concomitant hepatic and pulmonary hydatid disease in a 10-year-old girl. Case presentation A ten-year-old Caucasian girl, a permanent resident of rural Crete, Greece, was admitted to hospital reporting fever, anorexia and fatigue that had been present for the previous four days. Her vital signs were as follows: body temperature, 37.8°C; blood pressure, 120/60 mm Hg; heart rate, 95 beats/min; and respiratory rate, 12 breaths/ min. The oxygen saturation was 96% while she was breathing ambient air. Pulmonary examination revealed decreased breath sounds and dullness to percussion over the right costophrenic angle. The rest of the physical examination results were normal. Laboratory investigations included a complete blood count, liver function tests and urine analysis; all results were within normal ranges except for 3% eosinophils on the white blood cell differential. On chest radiography, a 9.0 × 8.2 cm circular lesion was visualized in the right lower lobe (Figure 1). A computed tomography (CT) thoracic scan revealed a cystic fluidfilled mass, 9.0 cm in diameter, on the inferior lobe of the right lung (Figure 2). The girl's history of living in proximity to dogs and farm animals was suggestive of infection with E. granulosus. The eventuality of liver involvement was investigated; a CT abdominal scan examination revealed the presence of a hypodense cystic lesion of 7.9 × 7.2 cm in the left lobe of the liver (Figure 3). * Correspondence: danyfantakis@med.uoc. gr 1 Department of Pediatric Surgery, University General Hospital of Heraklion,