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Eur J Cardiothorac Surg 2003;23:258
© 2003 Elsevier Science NL

Letter to the Editor

Reply to Purohit

Atilla Eroglu*, Can Kürkçüoglu, Nurettin Karaoglanoglu

Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, 25240 Erzurum, Turkey

Received 9 November 2002; accepted 13 November 2002.

* Corresponding author. Tel.: +90-442-3166333; fax: +90-442-3166340
e-mail: atilaeroglu{at}hotmail.com

Key Words: Mediastinal hydatid cyst • Mediastinal cyst • Surgery • Mediastinal diagnosis • Complications

We congratulate Dr Manoj Purohit on his case and we appreciate his interest in our article.

Hydatid cyst is a parasitic disease frequently seen in sheep and cattle raising countries with poor sanitary conditions. The disease is encountered endemically in our region [1,2]. Primary hydatid cyst of the mediastinum is extremely rare. In our clinic 427 patients with thoracic hydatid disease were treated surgically in a 17 year period and only 11 of these cases had primary mediastinal hydatid cyst (2.6%).

Patients with mediastinal hydatid cyst may be asymptomatic and have only an incidental radiographic finding, but generally most patients are symptomatic. The presenting symptoms are determined by the size and location of the cyst and the affect of compression or erosion on the mediastinal structures. Chest pain, Horner's syndrome, dyspnea, cough, dysphagia, and fever are common findings [3,4]. Cardiovascular and neurologic complications are seldom seen. Superior vena cava syndrome has also been described in association with mediastinal hydatid cysts [5]. In our series 82% of the patients with mediastinal hydatid cysts were symptomatic and the majority had two or more symptoms. Substernal pain was the most common symptom.

Radiography of the chest and chest computed tomographic (CT) scanning are the most common used modalities for diagnosis of mediastinal hydatid cyst. CT is considered essential and is important for displaying the morphology, density, and limits of these lesions. The differential diagnosis in such cases can only be made by surgery.

The gold standard for therapy is radical removal of the germinative membrane and pericyst through the appropriate thoracic incision [2–4]. When the localization of the cyst and invasion to vital structures prevent the total excision, partial pericystectomy is the treatment of choice after removal of the germinative membrane. Postoperative albendazole or mebendazole was administered to all our patients and recurrence was not seen over a long period.

In summary, despite its rarity, primary hydatid cyst should be considered in the differential diagnosis of mediastinal cystic lesions in endemic and non-endemic regions.

References

  1. Karaolanolu N., Kürkçuolu I.C., Görgüner M., Erolu A., Türkyilmaz A. Giant hydatid lung cysts. Eur J Cardiothorac Surg 2001;19(6):914-917.[Abstract/Free Full Text]
  2. Erolu A., Kürkçuolu C., Karaolanolu N., Tekinbas C., Kaynar H., Ömer Ö. Primary hydatid cysts of the mediastinum. Eur J Cardiothorac Surg 2002;22:599-601.[Abstract/Free Full Text]
  3. Heras F., Ramos G., Duque J.L., Garcia Yuste M., Cerezal L.J., Matilla J.M. Mediastinal hydatid cysts: 8 cases. Arch Bronconeumol 2000;36:221-224.[Medline]
  4. Rakower J., Milwidsky H. Primary mediastinal echinococcosis. Am J Med 1960;29:73-83.
  5. Purohit M., Srivastava C.P., Yadav K.S. Primary mediastinal hydatid cyst. Indian J Chest Dis Allied Sci 1999;41(1):57-60.[Medline]




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