Management of liver hydatid cyst with intrathoracic rupture

Background: Liver Hydatid cyst with intrathoracic rupture is a rare complication, which may be life-threatening. Currently there is a lack of consensus about the best way of management. The aim of our study was to assess the characteristics and outcomes of patients presenting with liver hydatid cyst ruptured into the thorax and managed through a thoracic approach. Methods: The records of 113 patients managed between 1994 and 2018, in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia, were retrospectively analyzed. Results: There were 64 women and 49 men. The mean age was 48 years [13-86 years]. Reported signs were: chest pain in 68 cases (60.1%), fever in 49 cases (43.3%), dyspnea in 41 cases (36.2%), cough in 30 cases (26.5%), or pain in the right upper quadrant of the abdomen in 5 cases (4.4%), and 21 patients (18.5%) were admitted in emergency. The cysts were assessed with abdominal ultrasonography, CT-scan or both. Surgery was performed in 106 cases. The main procedure was cystectomy through thoraco-phrenotomy and ‘Lagrot’ on the liver in 57 cases (53.7%). Lung resections were performed in 17 cases: segmentectomy (2 cases), bilobectomy (2 cases), lobectomy (12 cases) and right pneumonectomy (1 case). Twenty three patients had a decortication. Mortality rate was 2.6% and morbidity rate was 23.5%. Conclusion: Intrathoracic rupture of liver hydatid cyst may be managed through an abdominal or a thoracic approach. The thoracic approach should be preferred whenever the lung or the pleura are involved. In some cases, a combined thoracic and abdominal approach should be considered in order to prevent recurrences.