Scientific Letter
An Unusual Occupant of the Pulmonary Artery
Un ocupante insólito de la arteria pulmonar
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Hallazgos operatorios tras clampaje de arteria pulmonar derecha y arteriotomía de la rama lobar inferior, en cuyo interior se evidencian membranas hidatídicas (D).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Teresa Gómez Hernández, María Rodríguez Pérez, Pilar García Hernández, Marcelo F. Jiménez López" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M. Teresa" "apellidos" => "Gómez Hernández" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Rodríguez Pérez" ] 2 => array:2 [ "nombre" => "Pilar" "apellidos" => "García Hernández" ] 3 => array:2 [ "nombre" => "Marcelo F." 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Teresa Gómez Hernández, María Rodríguez Pérez, Pilar García Hernández, Marcelo F. Jiménez López" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M. Teresa" "apellidos" => "Gómez Hernández" "email" => array:1 [ 0 => "mteresa.gomez.hernandez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María" "apellidos" => "Rodríguez Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Pilar" "apellidos" => "García Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Marcelo F." "apellidos" => "Jiménez López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario de Salamanca, Salamanca, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un ocupante insólito de la arteria pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1191 "Ancho" => 1427 "Tamanyo" => 261200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing hypodense nodular images in the interior of the right pulmonary artery suggestive of cysts in the axial, sagittal, and coronal projections (A–C). Intra-operative view after clamping of the right pulmonary artery and arteriotomy of the lower lobe branch, showing hydatid membranes in the interior (D).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A hydatid cyst in the pulmonary arteries is a very rare presentation of hydatid disease that has been published on a very few occasions. In most cases, it is caused by rupture and embolization of a cardiac cyst<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> or hematogenous dissemination from a hepatic focus.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> We report the case of a patient with hydatid cysts in the right lung and pulmonary artery, with no previous history of cardiac or hepatic hydatid disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">This was a 56-year-old man with no substance abuse or significant medical history who consulted his primary care physician due to a 2-week history of bloody expectoration accompanied by right chest pain. The chest radiograph revealed a polylobulated mass in the right lower lobe with hilar thickening, initially suggestive of lung cancer. Chest computed tomography showed a mass measuring 11<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8.8<span class="elsevierStyleHsp" style=""></span>cm in the right lower lobe with hypodense areas suggestive of cysts. The mass showed a 10<span class="elsevierStyleHsp" style=""></span>cm contact with pleural surface, extending with peribronchovascular distribution toward the hilar region. Multiple nodular images of similar characteristics measuring up to 4.5<span class="elsevierStyleHsp" style=""></span>cm were seen inside the artery. Radiological findings were suggestive of pulmonary hydatidosis with invasion of the right lower lobe artery (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After serological confirmation of <span class="elsevierStyleItalic">Echinococcus granulosus</span> infection, the case was presented before the multidisciplinary committee, and the decision was taken to start antiparasitic treatment with albendazole (400<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) and praziquantel (1800<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h), with follow-up CT for evaluating treatment response and subsequent surgical resection.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After 6 weeks of antiparasitic treatment, the radiological findings showed little reduction in mass size and persisting internal cavitated areas, along with significant neovascularization originating in the thoracic artery via the bronchial arteries, and in the celiac trunk, via the arteries of the diaphragm. The patient's lung function test results were within normal limits.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Surgical resection was performed, and antiparasitic treatment continued throughout the peri-operative period. Intraoperative findings included hepatization of the lower right lobe, significant vascularization originating in the bronchial arteries, and increased caliber of the right lower lobe artery. After control and clamping of the right pulmonary artery at the extrapericardiac origin, arteriotomy was performed at the lower lobe branch, and the intravascular hydatid cysts were extracted (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>D). The proximal lumen of the pulmonary artery was aspirated to the level of the clamp. Given the significant perihilar inflammatory reaction, the proximal intermediate bronchus could not be resected, so a middle-lower bilobectomy was performed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The only post-operative complication presented by the patient was prolonged air leak. He was discharged on day 8 after surgery, and referred to the infectious diseases department for follow-up and control of his medical treatment.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Hydatidosis is a parasitic infection caused by the larval forms of <span class="elsevierStyleItalic">Echinococcus granulosus</span>. The most commonly affected organs are the liver (70%) and the lungs (25%). About 10%–15% of the embryos can spread to other organs via the systemic circulation, including the chambers of the heart, interventricular septum and pericardium (0.02%–2%).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The pulmonary arteries are an exceptionally rare site of involvement. In our case, the hydatid cyst was located at the level of the right lower lobe, within the right lower lobe artery, presumably due to the parasite implanting in the arterial lumen after crossing the wall through small lesions in the intima, aneurysms, or via the feeder vessels.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A hydatid cyst located within the pulmonary artery is associated with high mortality rates due to secondary dissemination, embolization, or anaphylactic shock after rupture.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Hydatid cysts are known to grow 2–3<span class="elsevierStyleHsp" style=""></span>cm/year. Within vessels, cysts grow slowly inside the lumen until it is obstructed. In pulmonary arteries, this process may be sufficiently slow to allow pulmonary perfusion to be adequately established via the bronchial arteries or other collateral branches. This explains why patients may be initially asymptomatic, and why our patient had no signs of occlusion despite total occlusion of the right lower lobe artery.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The differential diagnosis of hydatid cysts in the pulmonary artery should include pulmonary thromboembolism (fat, amniotic fluid, septic emboli, exogenous material) and primary tumors of the pulmonary artery, such as sarcomas.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Due to the high risk of cyst rupture and anaphylactic shock, surgery should be performed as soon as possible after diagnosis. The extraction of endovascular cysts even in asymptomatic patients is recommended.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> As this form of hydatidosis is so rare, no standardized surgical techniques have been described, so treatment must be individualized. The approach will depend on the adherence of the hydatid cyst to the arterial wall and its anatomical location. Surgical treatment must focus on preventing cyst rupture and migration, which may have fatal consequences, such as secondary dissemination, embolism, anaphylactic shock, and the formation of pseudoaneurysms.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> In our case, we clamped the right pulmonary artery to avoid such complications. Unilateral obstruction of the pulmonary artery can be successfully treated with arteriotomy and cyst resection with or without lung resection, or with pulmonary endarterectomy. In situations of concomitant pulmonary and arterial involvement, a 2-stage surgical intervention can be considered: first, resection of the intra-arterial hydatid cyst, followed by cystectomy or lung resection.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Recommended treatment of intra-arterial hydatidosis is surgical intervention followed by complementary medical treatment. CT follow-up is indicated to detect possible recurrences or development of pseudoaneurysms.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez Hernández MT, Rodríguez Pérez M, García Hernández P, Jiménez López MF. Un ocupante insólito de la arteria pulmonar. Arch Bronconeumol. 2017;53:402–404.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1191 "Ancho" => 1427 "Tamanyo" => 261200 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest computed tomography showing hypodense nodular images in the interior of the right pulmonary artery suggestive of cysts in the axial, sagittal, and coronal projections (A–C). Intra-operative view after clamping of the right pulmonary artery and arteriotomy of the lower lobe branch, showing hydatid membranes in the interior (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac hydatid disease: literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Abhishek" 1 => "V. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 5 | 10 |
| 2024 October | 48 | 26 | 74 |
| 2024 September | 61 | 20 | 81 |
| 2024 August | 83 | 51 | 134 |
| 2024 July | 82 | 20 | 102 |
| 2024 June | 93 | 24 | 117 |
| 2024 May | 89 | 21 | 110 |
| 2024 April | 78 | 30 | 108 |
| 2024 March | 74 | 17 | 91 |
| 2024 February | 75 | 21 | 96 |
| 2023 September | 1 | 1 | 2 |
| 2023 April | 0 | 1 | 1 |
| 2023 March | 6 | 4 | 10 |
| 2023 February | 58 | 23 | 81 |
| 2023 January | 44 | 43 | 87 |
| 2022 December | 63 | 35 | 98 |
| 2022 November | 61 | 29 | 90 |
| 2022 October | 75 | 40 | 115 |
| 2022 September | 41 | 25 | 66 |
| 2022 August | 38 | 41 | 79 |
| 2022 July | 40 | 48 | 88 |
| 2022 June | 30 | 37 | 67 |
| 2022 May | 30 | 36 | 66 |
| 2022 April | 33 | 38 | 71 |
| 2022 March | 50 | 40 | 90 |
| 2022 February | 35 | 30 | 65 |
| 2022 January | 56 | 38 | 94 |
| 2021 December | 34 | 42 | 76 |
| 2021 November | 44 | 41 | 85 |
| 2021 October | 39 | 47 | 86 |
| 2021 September | 32 | 36 | 68 |
| 2021 August | 29 | 35 | 64 |
| 2021 July | 25 | 21 | 46 |
| 2021 June | 67 | 49 | 116 |
| 2021 May | 28 | 34 | 62 |
| 2021 April | 89 | 74 | 163 |
| 2021 March | 38 | 31 | 69 |
| 2021 February | 21 | 20 | 41 |
| 2021 January | 27 | 15 | 42 |
| 2020 December | 35 | 26 | 61 |
| 2020 November | 27 | 17 | 44 |
| 2020 October | 46 | 14 | 60 |
| 2020 September | 30 | 8 | 38 |
| 2020 August | 41 | 16 | 57 |
| 2020 July | 34 | 23 | 57 |
| 2020 June | 22 | 4 | 26 |
| 2020 May | 21 | 9 | 30 |
| 2020 April | 22 | 21 | 43 |
| 2020 March | 17 | 16 | 33 |
| 2020 February | 29 | 20 | 49 |
| 2020 January | 25 | 19 | 44 |
| 2019 December | 32 | 18 | 50 |
| 2019 November | 18 | 24 | 42 |
| 2019 October | 24 | 25 | 49 |
| 2019 September | 19 | 16 | 35 |
| 2019 August | 21 | 12 | 33 |
| 2019 July | 16 | 24 | 40 |
| 2019 June | 19 | 27 | 46 |
| 2019 May | 39 | 34 | 73 |
| 2019 April | 30 | 46 | 76 |
| 2019 March | 25 | 32 | 57 |
| 2019 February | 26 | 15 | 41 |
| 2019 January | 17 | 22 | 39 |
| 2018 December | 15 | 13 | 28 |
| 2018 November | 57 | 26 | 83 |
| 2018 October | 105 | 17 | 122 |
| 2018 September | 37 | 7 | 44 |
| 2018 May | 18 | 1 | 19 |
| 2018 April | 56 | 4 | 60 |
| 2018 March | 38 | 5 | 43 |
| 2018 February | 47 | 8 | 55 |
| 2018 January | 166 | 5 | 171 |
| 2017 December | 117 | 7 | 124 |
| 2017 November | 17 | 6 | 23 |
| 2017 October | 22 | 12 | 34 |
| 2017 September | 0 | 1 | 1 |
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