Pulmonary, Splenic and Hepatic Hydatidosis : An Unusual Multivisceral Location in Children : A Case Report
by M. El Massi1*, O. Maïga1, K. Elfakiri1, N. Rada1, G. Draiss1, N.Aballa2, E.E. Kamili 2, M. Bouskraoui1
1Department of Pediatrics A , Cadi Ayyad University, Mother and Child Unit, Mohamed VI Teaching Hospital, Marrakesh, Morocco
2General Pediatric Surgery, Cadi Ayyad University, Mother and Child Unit, Mohamed VI Teaching Hospital, Marrakesh, Morocco
*Corresponding author: Marwa ElMassi, Department of Pediatrics A , Cadi Ayyad University, Mother and Child Unit, Mohamed VI Teaching Hospital, Marrakesh, Morocco
Received Date: 12 August, 2023
Accepted Date: 13 October, 2023
Published Date: 16 October, 2023
Citation: El Massi M, Maïga O, Elfakiri K, Rada N, Draiss G, et al. (2023) Pulmonary, Splenic and Hepatic Hydatidosis : An Unusual Multivisceral Location in Children : A Case Report. J Surg 8: 1913 DOI: https://doi.org/10.29011/2575-9760.001913
Hydatid cyst is a parasitosis due to the development of the larval form of Echinococcus granulosus which can infest all organs. The pulmonary location comes in 1st position followed by the liver and the spleen. The discovery is generally fortuitous on ultrasound. Hydatid serology guides the diagnosis. Surgical treatment, whether conservative or radical, gives good results. We report the case of a 10-year-old child from Morocco, without any history, who consulted us for a dry cough associated with a medium-sized hemoptysis, a thoracic pain of the right hemithorax and a heaviness of the right hypochondrium revealing a hepatic and splenic hydatid cyst. Although splenic and hepatic hydatidosis remains rare in the pediatric population, this observation serves to emphasize this pathology as well as other differential diagnoses.
Human echinococcosis is a zoonosis, caused by parasites, the tapeworms of the genus Echinococcus. There are essentially two forms of echinococcosis, cystic echinococcosis or hydatidosis, due to Echinicoccus granulosus, and alveolar echinococcosis, due to E. multilocularis. Hydatidosis or cystic echinococcosis is a public health problem in livestock areas of developing countries, particularly in the Mediterranean basin, North Africa, Latin America, Australia, New Zealand, China and Central Europe. Overall, exposure to food and water contaminated with feces from an infected host or poor hygiene in areas of infestation can cause this disease. The splenic localization comes in 3rd position after the liver and the lungs, but any organ can be affected, with simultaneous localization to one or more viscera. The presentation of primary dissemination through multi-organ involvement is very rare, especially in the pediatric population. In the absence of truly effective medical treatment, splenic hydatidosis often leads to surgery. We report the case of a 10 year old child with splenic hydatidosis revealed by a medium-sized hemoptysis associated with a dry cough admitted to the pediatric ward of the University Hospital of Marrakech, after free and informed consent by the parents.
Keywords: Child; Hydatid cyst; Hydatidosis; Liver; Spleen; Splenectomy
The child was El.A., 10 years old, with no particular pathological history, vaccinated up to date according to the national immunization program. He presented for four days with a dry cough associated with four episodes of moderate hemoptysis, chest pain in the right hemithorax and heaviness in the right hypochondrium, all evolving in a context of uncalculated fever and conservation of the general condition. On clinical examination, the patient was conscious, polypneic at 25cpm, normocardial, apyretic at 36.6°C, SpO2 at 98% on room air, with normal staturo-ponderal development. The pleuropulmonary examination showed right basithoracic crackling rales without signs of respiratory struggle. Abdominal palpation revealed tenderness in the left hypochondrium. In front of this presentation, three diagnoses were evoked: a hydatid cyst, pulmonary tuberculosis and pneumonia. A chest radiograph showed an alveolar opacity of the middle lobe (Figure 1).
Figure 1: Frontal chest radiograph showing an alveolar-type opacity occupying the middle lobe in a child El.A.
An abdominal ultrasound was performed, the aspect of which was in favor of hepatic hydatid cysts in segments VII (13.5*3.1mm) (Figure 3), II (18*15.1mm) (Figure 4) and I (16.1*4. 7mm) (Figure 5) and splenic type I of the GHARBI classification (Figure 2), oval shape, well limited, anechogenic content, generating a posterior enhancement, non vascularized on color Doppler measuring 53*52mm.
Figure 2: Anechoic splenic cystic formation, roughly rounded in shape with a thin wall and no partitions or endocystic vegetations generating a posterior reinforcement.
Figure 3: Cystic formation of segment VII measuring 13.5*13.1mm.