AJTCCM VOL. 29 NO. 1 2023 29
PICK OF THE PICS
A 26-year-old man, previously healthy, a
lifelong non-smoker and HIV negative, was
found to have a large le pleural eusion in
the course of screening for a job on a cruise
ship. He was completely asymptomatic
with no abnormal clinical ndings. A chest
radiograph revealed a large le pleural eusion
(Fig.1) and massive le hilar, mediastinal and
subcarinal adenopathy. e primary concerns
were aggressive lymphoma in a young patient
or pulmonary tuberculosis.
A computed tomography scan subsequently
revealed multiple multilocular cystic lesions in
the le hemithorax involving the mediastinum
with multiple internal daughter cysts. e most
caudal lesion in the le cardiophrenic angle
had a convoluted appearance in keeping with
detached membranes (likely to be a ruptured
hydatid cyst) (Fig. 2).
Serological testing for Echinococcus
by enzyme-linked immunosorbent assay
conrmed the diagnosis of pulmonary cystic
echinococcosis with high titres of IgG.
Lung hydatidosis is a zoonosis related
to infection by the Echinococcus tapeworm
species.[1] e diagnosis of pulmonary cystic
echinococcosis is primarily made by imaging,
and surgery remains the main therapeutic
approach.[2]
e patient was referred to cardiothoracic
surgery and underwent hydatid debulking via
thoracotomy.
1. Lupia T, Corcione S, Guerrera F, et al. Pulmonary
echinococcosis or lung hydatidosis: A narrative review.
Surg Infect (Larchmt) 2021;22(5):485-495. https://doi.
org/10.1089/sur.2020.197
2. Santivanez S, Garcia HH. Pulmonary cystic echinococcosis.
Curr Opin Pulm Med 2010;16(3):257-261. https://doi.
org/10.1097/MCP.0b013e3283386282
Abnormal chest radiograph in an asymptomatic young man –
whatis the dierential diagnosis?
T H A Zobair,1 MB ChB, MD, Cert Pulmonology (SA), MPhil; N Singh,1 MB ChB, MMed (UCT), FCP (SA), Cert Pulmonology (SA);
M A S Alameen,2 MB ChB; Q Said-Hartley,3 MB ChB, FC Rad (SA); M Lephoi,4 BSc, MB ChB; R I Raine,1 MB ChB, MMed (Med), FCP (SA)
1 Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
2 Mediclinic Hospital-Abu Dhabi, United Arab Emirates
3 Division of Radiology, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
4 Chris Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
Corresponding author: T H A Zobair (dr.tarig@hotmail.com)
Fig 1. Frontal (A) and lateral (B) chest
radiographs showing a large opacity within the
le hemithorax with loss of the le costophrenic
and cardiophrenic angles associated with
a meniscus, and mild deviation of the
mediastinum to the right in keeping with a
large le pleural eusion. Associated hilar and
mediastinal lymphadenopathy is present.
A
B
Fig.2. Computed tomography scans of the chest
in lung window (A) and so-tissue window (B
and C). e scans conrm the large le pleural
eusion with multiple thin-walled multilocular
cysts containing daughter cysts. e cysts invade
the mediastinum and abut the pulmonary
artery and descending thoracic aorta.
A
B
C
