Hepatopulmonary Fistula: a life threatening complication of hydatid disease
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CASE REPORT
Open Access
Hepatopulmonary Fistula: a life threatening complication of hydatid disease Mohamed Amirali Gulamhussein1, Davide Patrini1*, Jonathan Pararajasingham1, Benjamin Adams1, Rajeev Shukla1, Dimitrios Velissaris2, David Lawrence1 and Nikolaos Panagiotopoulos1
Abstract Despite extensive infection control measures against parasitic diseases, hydatid disease, caused by Echinococcus granulosus, still occurs in a minor group of our population. If the infection is not treated adequately, it goes on to developing life-threatening complications, one of which is hepatopulmonary fistula. These complications usually warrant early surgical intervention, or else may lead to extensive sepsis and ultimately death. We discuss the case of an elderly female suffering from pulmonary hydatid disease, further complicated by a hepatopulmonary fistula and underwent surgical treatment. This case emphasises the importance of early recognition of pulmonary hydatid disease given its atypical nature of presentation before the disease is further exacerbated by this aggressive complication. Furthermore, it is imperative to incorporate radical surgery as the first-line treatment in established hepatopulmonary fistula, in order to prevent further clinical deterioration and curative outcome. Keywords: Hydatid disease, Hepatopulmonary fistula, Thoracotomy
Background Hepatopulmonary fistulae, although rare entities, are a common complication of hydatid or amoebic liver disease. The fistula normally forms through transdiaphragmatic penetration, leading to rupture as a large cyst into the lower lobe of the lung. These fistulae may arise due to other secondary causes as well, such as congenital malformations, penetrating liver trauma, hepatobiliary surgery, biliary obstruction and most importantly infective suppuration. Intrapulmonary rupture of a hepatic hydatid cyst is usually uncommon and the underlying cause is mostly the perforation from the right subphrenic space into the posterior basal segment of the right lower lobe [1]. Other routes of fistula formation involve the presence of an underlying infected biloma where the biliary stasis predisposes to an extensive suppurative process, which leads to rupture and erosion through the diaphragm into the pleural space, bronchus or both [2, 3]. This case emphasises the importance of early recognition of a developing fistula and the use of aggressive surgical treatment at an early stage, which has reduced * Correspondence: [email protected] 1 Department of Cardiothoracic Surgery, University College London Hospitals (UCLH), 16-18 Westmoreland Street, London W1G 8PH, UK Full list of author information is available at the end of the article
the associated morbidity and mortality from the sequelae of this disease in majority of the cases.
Case presentation A 69-year old Caucasian lady presented to the emergency department with a two day history of haemoptysis, pleuritic chest pain and dyspnoea. She had a productive cough with thick, yellowish sputum, associated with intermitte
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