Page 86 - Livre électronique des Rencontres Franco-Tunisiennes de Pneumologie 2019

P49. A RARE CASE OF PLEURAL HYDATIDOSIS DISCOVERD AFTER A PLEURAL
PUNCTURE

LOBNA LOUED, WAFA BENZARTI, SANA AISSA, WAJIH GHRIBI, AHMED ABDELGHANI,
ABDELHAMID GARROUCHE, ABDELAZIZ HAYOUNI, IMEN GARGOURI, MOHAMED BENZARTI
DEPARTEMENT OF PNEUMOLOGY AT FARHAT HACHED HOSPITAL, SOUSSE

Background :

The hydatid cyst is still endemic in Tunisia. The lung presents the second location after the liver
but pleural location is rare.
Case presentation :

We report the case of a 34-year-old man living in a rural setting with a family history of hepatic
hydatidosis in both father and sister. The patient was hospitalized a year ago in our Department
for a purulent pleurisy treated by antibiotics with a good clinical and biological evolution. In the
chest X-ray, the patient kept a pleural thickening. A year later, the patient consults for right chest
pain and fever. Clinical examination revealed a right pleural syndrome and a temperature at 39°C.
However, the patient had no extra thoracic signs and there was no respiratory or hemodynamic
instability. The chest X-ray showed a right homogenous opacity consistent with a pleural effusion.
A recurrence of purulent pleurisy was suspected and an exploratory pleural puncture was
performed. The liquid brought back was clear. Parasitological examination of the liquid showed
the presence of Echinococcus Granulosus hooks. A thoracic ultrasound showed the presence of
multiple pleural cysts. Thoracic and abdominal CT scan showed pleural and mediastinal
hydatidosis with an intimate contact with the right atrium. A cardiac ultrasound showed the
absence of intracardiac cysts. The patient was put on antibiotics and a surgical treatment was
planned.

Conclusion:

Primary pleural hydatidosis is rare, the slightest doubt should lead the practitioner to perform the
appropriate biological and radiological examinations to confirm the diagnosis. The management
is based on surgery that is not free of surgical difficulties and risks. Primary prevention remains
the key to reduce the incidence of this parasitological disease.

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