RUPTURED PULMONARY HYDATID CYST PRESENTING AS PLEURAL EFFUSION IN A THIRD TRIMESTER PREGNANT WOMAN

Background: Hydatid disease is a zoonotic disease caused by infection with Echinococcus granulosus .Pulmonary hydatid cyst often becomes symptomatic after cyst rupture in the pleural cavity or bronchus.Pulmonary hydatid cyst may be misdiagnosed and therefore patients may receive inappropriate treatment.In this case, a 27-year-old full term pregnant female presented with sudden onset dyspnea and hypoxia. Upon further evaluation, it was found to be a ruptured hydatid.

Case Report: A 27 year old full term(36 weeks) pregnant patient was admitted with sudden onset of dyspnea,fever and hypoxia(SpO2-84% (RA)).Patient was evaluated and obstetric parameters were found to be within normal limits. Chest X-Ray revealed a right homogenous opacity with CP angle blunting.Diagnostic thoracocentesis showed an exudative effusion which was pale in colour.Immunoglobin-G enzyme-linked immunosorbent assay for Echinococcus was positive.HRCT Thorax showed a right sided ruptured hydatid cyst.ICDT insertion was done,fluid drained and Abendazole was started.Patient showed progressive improvement and had a normal vaginal delivery. A seven months follow up found the patient to be healthy and free of symptoms.

Discussion: Pulmonary hydatid cyst most commonly appears in the lower lobe of the right lung, and is usually solitary. These cysts may initially be asymptomatic.Pulmonary hydatid cysts rupture in about a third of patients,leads to secondary hydatid spread, asphyxia, anaphylactic shock, acute respiratory failure, massive hemoptysis, and circulatory collapse.Ruptured pulmonary hydatid cyst may be misdiagnosed as pneumonia, tuberculosis, lung abscess, tumor, or pneumothorax.

Conclusion:Hydatid cyst rupture should be suspected in patients from areas where Echinococcus is endemic.In symptomatic cases surgical excision with Tab.Albendazole for minimum 3 to 6 months duration is the main stay of treatment.