The surgical treatment of bilateral lung hydatid lobe cysts involves removing the affected lobe. In the majority of cases, the surgeon uses a thoracoscopic approach. The operative technique used will depend on the location of the hydatid. Most cases are managed conservatively with a thoracotomy or minithoracotomy.
Patients with hydatid cysts of the upper part of the liver are often managed by thoracic surgeons. These patients often undergo a thoracotomy, which provides better access to the impacted lobe. The patient may require additional testing to confirm the diagnosis. The most effective treatments for pulmonary hydatid cysts involve a combination of surgical techniques.
The most effective treatment for a complicated hydatid cyst is enucleation, in which the intact hydatid is removed from the cystic cavity. The procedure requires a carefully dissected pericystic layer. Blunt dissections separate the pericyst from the laminated membrane. After enucleation, the anesthesiologist inflates the lung and the surgeon then applies gentle manual pressure to the surrounding lung.
A posterolateral thoracotomy is the preferred surgical approach for bilateral lung hydatid lobe cysts. The doctor performs this operation using the fifth, sixth, and seventh intercostal spaces. After the surgery, the hypertonic sodium chloride solution is injected into the lungs and the resulting fluid is removed. After this procedure, the patient may need to undergo repeat imaging if the hydatid lobule recurrence is necessary.
The most common surgical option for a hydatid lobe cyst is a transdiaphragmatic approach. This method allows doctors to reach the hydatid lobule in both sides of the lungs. This approach is recommended for patients with an uncancerous hydatid loboma. The first thoracotomy is performed via the left side of the thorax.
There are several complications associated with hydatid lobe cysts. Some patients develop anaphylaxis after a hydatid lobuloma. Infection and prolonged air leak are the most common complications. In two patients, the hydatid loboma was associated with a pleural perforation.
Patients with hydatid lobe cysts may present with chest pain, fever, and a thoracic bulge. Despite its nonspecific symptoms, an intact pulmonary hydatid lobuloma can cause hemoptysis and a tension pneumothorax. When this happens, treatment options may be more difficult than usual.
Patients with bilateral lung hydatid lobe cysts may experience symptoms similar to those of patients with a unilateral lobe hydatid lobuloma. A well-defined round radiopaque shadow is the diagnostic hallmark of a hydatid loboma. A hematoma may rupture into the pleural cavity or into the bronchial tree. When the cyst ruptures, the resulting infection may lead to a bronchopleural fistula, pulmonary abscess, or empyema.