Results
Among the eight children, five were boys. The age ranged from 6 to 12
years. Cough was present in seven children; it was dry in four and wet
or productive in three cases. Fever was present in five children. Other
symptoms were chest pain, hemoptysis and dyspnea. On examination,
localized chest findings were present in six children. Five of them had
reduced breath sounds with dullness on percussion, while one had
bronchial breathing. One child had been treated as empyema 2 years back
in another hospital, and another child had received treatment for lung
abscess. They presented to our hospital because of non-resolution. Table
1 presents a summary of the clinical findings.
All children presented to us with chest xrays and CT scans done
elsewhere. Xrays showed cystic lesion in one patient, homogenous
consolidation with rounded contours in two and non-specific localized
consolidation in the other five cases. CT scan showed fluid filled
cystic lesions in two, while the others showed consolidation with or
without central cavitation. One child also had a right paratracheal
cystic lesion. The radiographic findings are summarized in Table 1. Four
children had an eosinophil count above 500 per microlitre. Hydatid
serology was positive in six children. One child had an additional cyst
in segment V of the liver.
Flexible fibreoptic bronchoscopy showed white or yellow glistening
membranes occluding the main, lobar or segmental bronchi, in all but one
patient. The location corresponded to the involved lobe identified on
imaging. BAL specimens were carefully obtained in seven children.
There were no systemic adverse events during any of these procedures,
including hemodynamic instability, anaphylactic reaction or other post
procedure complications. However, in one child, there was a gush of
fluid return during BAL that turned mildly haemorrhagic and required
prolonged suctioning. No other intervention was required in this child.
Cytopathologic examination of seven BAL specimens showed acellular
lamellated membranes in two specimens, and non-specific inflammatory
cells in the remaining five. Membranes were brightly positive on
Periodic acid-Schiff (PAS) stain. Two BAL specimens had solid fragments
wherein histopathologic examination showed acellular eosinophilic
lamellated membrane representing hydatid ectocyst in both. Hydatid
germinal layer could also be seen in one of them. Cytologic examination
in these two specimens did not show any hydatid elements. Thus
pathologic confirmation was obtained in four of seven BAL specimens.
Seven children were referred for surgery and histopathology of the
excised cysts confirmed hydatid disease. The patient who did not have
membranes on bronchoscopy had a normal BAL examination. This child had
positive serology and was treated for hydatid without surgery.
Bronchoscopy showed membranes in two children with negative serology.
Overall, flexible bronchoscopy with BAL analysis could confirm the
diagnosis in seven of eight children patients prior to surgery.