Introduction
Hydatid disease is a worldwide zoonosis, but endemic in some regions.
Cystic hydatid disease or hydatidosis is caused by the cestodeEchinococcus granulosus , whereas alveolar hydatid disease is
caused by Echinococcus multilocularis . The cestode life cycle
requires a definitive host that harbours the mature parasite and an
intermediate host for the immature stage of the parasite. Humans are
accidental dead end hosts, who acquire the eggs via the feco-oral route.
The liver is most often affected in adults, whereas lungs are more
frequently involved in children1. The clinical
presentation depends on cyst site, size and complications like
infection. In more than one-third cases, the condition can be
asymptomatic2. Symptomatic children develop cough,
chest pain, shortness of breath, expectoration, fever and hemoptysis.
The diagnosis can be suspected on the basis of endemicity, history of
exposure to sheep or dogs, chest imaging showing a single or multiple
cysts and positive serology test. Uncomplicated pulmonary cysts appear
as homogenous radio opacities on chest xray and well circumscribed fluid
attenuation lesions on CT. Complicated cysts sometimes have appearances
described as crescent sign, cumbo sign, water lily sign, etc., however,
there may be atypical radiologic signs. Chest ultrasonography may detect
peripheral lesions. ELISA for IgG antibodies has sensitivity of 85-98%
for liver cysts, but only 50-60% for lung cysts, thereby creating false
positive and false negative reports3. Percutaneous
aspiration of the cyst carries the risk of rupture and an anaphylactic
reaction. Thus, there is no established method to confirm the diagnosis
and this can be done only by pathologic examination of surgically
excised cysts.
Here we report a series of eight children with suspected and unsuspected
lung hydatid who underwent bronchoscopy and bronchoalveolar lavage (BAL)
under conscious sedation. We were able to confirm hydatid disease in
seven children using this novel approach.