Massive Life-Threatening Hemoptysis from Pulmonary Hydatid Cysts: A 13-Year Experience from an Endemic Area

Echinococcosis is a parasitic disease often seen in sheep and cattle raised in countries with unsanitary conditions. The disease is encountered endemically in northwest of Iran. Life-threatening hemoptysis due to a pulmonary hydatid cyst is a rare condition. This study assessed the prevalence and treatment of this condition. In a retrospective study, between 1993 and 2005, 520 patients with pulmonary hydatid cysts were operated at the Imam Khomeini Hospital in Tabriz, Iran. Ten (1.9%) cysts exhibited life-threatening hemoptysis (Group II). The remaining 510 patients with pulmonary hydatid cyst were studied (Group I) and compared with group II. Ten patients were included in group II, with a mean follow – up of 2.5 years. Four (40%) cases were males and six (60%) were females. The age ranged between 8 and 46 (mean 27.90 ± 13.86) years. The most common symptoms were cough (100%), massive hemoptysis (100%), respiratory distress (100%), and chest pain (90%). The amount of hemoptysis was between 600 and 1400 ml (mean 840 ± 249.66) a day. The origin of bleeding in six (60%) was from the cyst in the right lung and in four (40%) from the left lung. Bronchoscopy revealed the site of bleeding in all 10 patients, and the lobe in seven (70%). Chest x-ray and CT scan showed patchy infiltration in one or both lungs and a ruptured hydatid cyst in eight cases. Lobectomy was the most frequent applied procedure (100%). Two (20%) cases died due to blood aspiration and respiratory distress syndrome, one in the 3rd and the other in the 4th postoperative day. The postoperative hospital stay ranged between 7 and 25 (mean 11.30 ± 6.56) days. Two and a half years follow-up of patients was good. There was no recurrence. There were significant differences between the two groups In terms of complications and mortality (c2 =102.39, df=1, p<0.0005) and (c2 = 5.82, df=1, p<0.16). Massive life-threatening hemoptysis due to pulmonary hydatid cysts must be managed as an urgent clinical entity. It has serious symptoms, serious post-operative complications and a high mortality rate.