Thoracic Migration of Hepatic Hydatid Cysts: A Study of 63 Cases

Abstract

Thoracic migration of hepatic hydatid cysts is a rare but serious complication of hepatic hydatidosis. It occurs when a hepatic cyst, in contact with the diaphragm, ruptures into the thoracic cavity, leading to pulmonary and pleural manifestations. This retrospective study was conducted over a 24-years period in the thoracic surgery department of Abderrahmen Mami Hospital, Tunisia. The objective was to analyze the therapeutic characteristics of thoracic migration of hepatic hydatid cysts. A total of 63 cases were collected. The mean age was 48.1 years, 31 men (49.2%) and 32 women (50.8%). The most commonly reported symptoms were chest pain (88.9%) and cough (77.8%), followed by dyspnea (33.3%), hemoptysis (31.7%), and, less frequently, bilioptysis (4.7%). Surgical management mainly involved a right postero-lateral thoracotomy in 82.5% of patients. Pulmonary resection was necessary in 19 patients (30.16%), including 11 middle lobectomies, 5 right lower lobectomies, 2 bilobectomies, and 1 segmentectomy. Diaphragmatic suture was performed in all patients, without edge excision in 44 cases and with edge resection in 19 cases. Postoperatively, the average hospital stay was 15 days. Mortality was 4.76% (3 cases), attributed to septic and thromboembolic complications. Morbidity included biliary fistulas (4 cases), wound infections (7 cases), and a subphrenic collection (1 case). Five cases of recurrence were observed, including 3 hepatic and 2 pleural recurrences. Thoracic migration of hepatic hydatid cysts requirs a multidisciplinary approach. Early intervention and an adapted approach improve patient prognosis and reduce morbidity.