S Nadeem Ali Shah.
Hydatid disease presenting as a mass lesion of thoracic wall simulating a malignant growth.
J Coll Physicians Surg Pak Jan ;11(5):335-6.

Hydatid disease is not an uncommon disease in N.W.F.P. presenting with a variety of symptoms, signs and radiological features. A case of hydatid disease of chest wall is presented that resulted in erosion of adjacent ribs, simulating malignant mass lesion. Diagnosis suspected on CT scan was confirmed after complete excision and back table dissection of the resected specimen.

Case Report: A 50 years old male was admitted in cardiothoracic ward, Lady Reading Hospital, Peshawar, with swelling on his right chest wall. It was noticed eight months back which gradually increased in size. There was a complaint of local discomfort, increasing to pain with coughing and sneezing but not with deep breathing. There was no history of cough, fever, dyspnoea, anorexia, night sweats, weight loss or trauma to the region. On physical examination there was a visible swelling on the posteriolateral aspect of his chest wall inferiorly with overlying healthy mobile skin. The swelling was rounded 9 x 8 cms in size, non tender, non pulsatile, partially solid/cystic with well defined margins. Its temperature was normal and was fixed to the chest wall deeply. Air entry on both sides of the chest was normal. Liver span was also normal. Patient was afebrile and the lymph nodes in the axilla, groin and cervical region were not palpable. Plain x-ray chest showed a dumbbell shaped swelling partly intrathoracic with erosion of adjacent ribs. Lung fields were clear, with no pleural effusion.

Indirect hemagglutination test and compliment fixation test were negative. Facilities for measurement of antibodies for E granuloma were not available. Fine needle aspiration cytology was done by mistake before CT scan pictures were available. It was inconclusive except in revealing its cystic component filled with hemorrhagic fluid. Ultrasound examination of the swelling showed it to be partially cystic and solid. Ultrasound abdomen was normal. CT Scan suggested it to be hydatd, but the possibility of a malignant leision with multiple areas of hemorrhages could not be excluded. Rest of the investigations were normal. Right posterolateral thoracotomy was performed and the swelling was removed in toto with portions of adjacent ribs. Chest intubation was done with under water sealed drainage. The resulting defect was covered with the native muscles and skin. Postoperative recovery was uneventful. Chest drain was removed on second postoperative day and x-ray chest showed a completely expanded lung. The resected specimen on bisection revealed numerous daughter cysts, blood clots and blood stained fluid. Adjacent ribs were eroded completely due to pressure necrosis. The specimen was sent for histopathology and the result showed no evidence of malignancy. Patient was discharged for home on a full course of albendazole.

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