Chest X-ray in a hypertensive patient with stage 2 diastolic dysfunction/Evre 2 diyastolik disfonksiyonu bulunan hipertansif bir hastada akciger grafisi.
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What is your diagnosis?
1. Diastolic dysfunction
3. Hydatid cyst
4. Local pleural liquid or empyema
Right answer: 3. Hydatid cyst
Her chest X-rays and thorax CT were evaluated again. There was a cystic mass located at the right major fissure.
Albendazol treatment was initiated preoperatively. The patient was operated after 6 weeks of treatment. Cyst excision was performed with right thoracotomy and wedge resection. Per operative diagnosis was also cyst hydatid. There was no per operative complication occurred. The pathological specimen was showed lamellar cuticular membrane, active-chronic inflammation and fibrosis which were relevant for cyst hydatid diagnosis. The remaining hospital stay was uneventful and patient was discharged with albendazol treatment. Cyst hydatid, a clinical entity endemic in many sheep and cattle-raising areas, is still an important health problem in the world. Extra-pulmonary location of cysts in the thorax is rare. Cysts in pleural fissures were indeed attached by a thin pedicle to the visceral pleura (1, 2). Surgery to obtain a complete cure is the treatment of choice for most patients with intrathoracic but extra-pulmonary cysts; excision must be done without delay to avoid or relieve compression of surrounding vital structures (3). Distinguishing hydatid disease from other pathologies like phantom tumor may be extremely difficult, even with CT. Due to uncontrolled hypertension and diastolic dysfunction in our patient may cause to suspect from diastolic heart failure and cystic mass as phantom tumor. The clinical presentation of the patient, physical findings and imaging techniques like chest-X-ray, ultrasonography and CT may be helpful in correct diagnosis. In addition, surgical excision and pathological examination confirm the diagnosis in these patients.
(1.) McManus DPP Zhang W, Li J, Bartley PB. Echinococcosis. Lancet 2003; 362:1295-304. [CrossRef]
(2.) Eckert J, Deplazes P Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004; 17:107-35. [CrossRef]
(3.) Miralles A, Bracamonte L, Pavie A, Bors V, Rabago G, Gandjbakhch I, et al. Cardiac echinococcosis. Surgical treatment and results. J Thorac Cardiovasc Surg 1994; 107:184-90.
Ugur Canpolat, Asena Gokcay Canpolat *, Necla Ozer
Departments of Cardiology and *Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara-Turkey
Address for Correspondence/Yazisma Adresi: Dr. Ugur Canpolat, Hacettepe Universitesi Tip Fakultesi, Kardiyoloji Anabilim Dali 06100, Sihhiye, Ankara-Tu'rk/ye Phone: +90 312 305 17 80 Fax: +90 312 305 41 37 E-mail: firstname.lastname@example.org Available Online Date/Cevrimici Yayin Tarihi: 23.05.2012
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|Title Annotation:||Diagnostic Puzzle/Tanisal Bilmece|
|Author:||Canpolat, Ugur; Canpolat, Asena Gokcay; Ozer, Necla|
|Publication:||The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)|
|Date:||Aug 1, 2012|
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