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Chylothorax due to hepatic alveolar echinococcosis with infiltration of diaphragm and left pleura: a case report

Authors :
Anne Schneider
Steffen Klengel
Christoph Lübbert
Henning Trawinski
Source :
BMC Infectious Diseases, Vol 23, Iss 1, Pp 1-5 (2023)
Publication Year :
2023
Publisher :
BMC, 2023.

Abstract

Abstract Background Alveolar echinococcosis (AE) is an endemic parasitic zoonosis in Germany. In most cases, the liver is the primary organ affected. Case presentation A 59-year old female patient presented with increasing exertional dyspnea and unintentional weight loss. A computed tomography (CT) scan showed a left-sided chylous pleural effusion and multiple intrahepatic masses with infiltration of the diaphragm and the pleura. The findings were initially misinterpreted as hepatocellular carcinoma (HCC) with infiltrating growth. Liver biopsy of one of the masses showed no evidence of malignancy, but an amorphous necrosis of unclear origin. HCC was further ruled out by magnetic resonance imaging (MRI). However, MRI findings were highly suspicious for hepatothoracic dissemination and complications due to AE. Typical histologic findings in a repeated and more specific examination of the liver tissue and a positive serology for echinococcosis confirmed the diagnosis of AE. As the hepatic and pulmonary manifestations were considered inoperable in a curative matter, an anti-parasitic treatment with albendazole was initiated. A video-assisted thoracoscopic surgery (VATS) with removal of the chylous effusion as well as a talc pleurodesis was performed to relieve the patient from dyspnea. Two months later, the patient was asymptomatic and a positron emission tomography (PET)-CT-scan with [18 F] fluoro-2-deoxy-d-glucose (FDG) showed a remarkable diminution of the hepatic manifestation. Conclusions This case demonstrates a rare presentation of alveolar echinococcosis with a focus on pulmonary symptoms, emphasizing the importance of evaluation for pulmonary involvement in patients with AE and respiratory symptoms.

Details

Language :
English
ISSN :
14712334
Volume :
23
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Infectious Diseases
Publication Type :
Academic Journal
Accession number :
edsdoj.fe83c8b3ee94c9495c990cbf0f71bf8
Document Type :
article
Full Text :
https://doi.org/10.1186/s12879-023-08180-5