An Aspergilloma in an Echinococcal Cyst Cavity

Abstract

Aspergilloma is a saprophytic infection which can colonize preexisting lung cavities. The most common underlying diseases are tuberculosis, sarcoidosis, cavitary lung cancer, etc. Although aspergilloma can also occur in operated hydatid cyst cavities, only a few cases have been reported in literature. A 32-year-old female patient underwent cystectomy for the diagnosis of perforated intraparenchymal giant hydatid cyst located in the right upper lobe, reaching down to the hilum. Capitonnage was not performed and it was observed that a residual cavity remained in the cystectomy area. The patient was discharged; however, during clinical and radiological follow-ups, it was found that the residual cyst cavity had expanded. As it was thought that one of the drainage bronchi in the cyst cavity could have opened, the patient was reoperated. During the operation, it was noted that purulent fluid and necrotic tissues were present in the cystic cavity. It was seen that the posterior upper lobe segment was consolidated and not ventilated. Contents of the cavity were removed and the posterior upper lobe segment was resected. Histopathological examination revealed that the tissue in the cavity was that of an aspergilloma, and that chronic organized pneumonia and diffuse interstitial fibrosis were present in the resected segment. Refraining from surgical obliteration (capitonnage) of cyst cavities in cases of giant hydatid cysts extending to the hilum can lead to opportunistic infections such as aspergilloma.

Key words

Hydatid cyst - mycetoma - aspergilloma

References

• 1 Addis B. Pulmonary mycotic disease - pulmonary aspergillosis. Spencer's Pathology of the Lung. New York; McGraw Hill 1996: 257-265
• 2 Glimp R A, Bayer A S. Pulmonary aspergilloma: diagnostic and therapeutic considerations.  Arch Intern Med. 1983;  143 303-308
• 3 Regnard J F, Icard P, Nicolosi M, Spagiarri L, Magdeleinat P, Jauffret B, Levasseur P. Aspergilloma: a series of 89 surgical cases.  Ann Thorac Surg. 2000;  69 898-903
• 4 Ulasan N G, Dural K, Yildirim E, Ozisik K, Sakinci U. An intracavitary aspergilloma after echinococcal cystectomy.  J Cardiovasc Surg. 2003;  44 289-290
• 5 Al-Kattan K, Ashour M, Hajjar W, Salah El Din M, Fouda M, Al Bakry A. Surgery for pulmonary aspergilloma in post-tuberculous vs. immuno-compromised patients.  Eur J Cardiothorac Surg. 2001;  20 728-733