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Cystic echinococcosis: An attraction for fungal and bacterial pulmonary infections

Oxana Munteanu

Oxana Munteanu

Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy ‘Nicolae Testemitanu’Chisinau,
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Munteanu, Oxana
, 
Dumitru Chesov

Dumitru Chesov

  • Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy ‘Nicolae Testemitanu’Chisinau,
  • Department of Clinical Infectious Diseases, Research Center BorstelBorstel, Germany
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Chesov, Dumitru
, 
Doina Rusu

Doina Rusu

  • Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy ‘Nicolae Testemitanu’Chisinau,
  • Department of Pneumology, Phthisiopneumology Institute ‘Chiril Draganiuc’Chisinau,
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Rusu, Doina
, 
Irina Volosciuc

Irina Volosciuc

Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy ‘Nicolae Testemitanu’Chisinau,
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Volosciuc, Irina
, 
Leonid Onea

Leonid Onea

Department of Radiology, German Diagnostic CenterChisinau,
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Onea, Leonid
 and 
Victor Botnaru

Victor Botnaru

Department of Internal Medicine, Division of Pneumology and Allergology, State University of Medicine and Pharmacy ‘Nicolae Testemitanu’Chisinau,
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Botnaru, Victor
  
Jul 27, 2020
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Article Category: Case Reports
Published Online: Jul 27, 2020
Page range: 57 - 63
DOI: https://doi.org/10.2478/pneum-2020-0007
Keywords
© 2020 Oxana Munteanu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Posteroanterior view of chest X-ray showing bibasilar opacities and ill-defined cavities (arrows) suggestive for forming lung abscess or cystic bronchiectasis. Note the elevation of the left hemidiaphragm with mediastinal shift and displacement of the trachea to the right.
Posteroanterior view of chest X-ray showing bibasilar opacities and ill-defined cavities (arrows) suggestive for forming lung abscess or cystic bronchiectasis. Note the elevation of the left hemidiaphragm with mediastinal shift and displacement of the trachea to the right.

Figure 2

The high-resolution computer tomography images demonstrate three well-defined cavitary lesion with different inside contents. A (axial reconstruction), B (coronal reconstruction) and C (sagittal reconstruction) demonstrate a well-circumscribed lesion around 4 cm in diameter, with thin, smooth walls, predominantly of fluid attenuation inside (12 HU) in the left upper lobe. D (axial reconstruction), E (coronal reconstruction) and F (sagittal reconstruction) show a cavitary lesion around 5 cm in diameter with thickened irregular walls, dense content inside and the air crescent sign (moon sign and meniscus sign) in the left lower lobe anteromedial segment. G (axial reconstruction, parenchymal window) and H (axial reconstruction, mediastinal window) show a 5-cm thin-walled cavity communicated with the airway with lobulated air–soft tissue interface (small air bubbles within the perforated pulmonary cysts – ‘air bubble’ sign, white arrow) in the right lower lobe posterolateral segment. (I) CT shows a defect in the right and left diaphragm with herniation of retroperitoneal fat tissue into the thorax (black arrows).
The high-resolution computer tomography images demonstrate three well-defined cavitary lesion with different inside contents. A (axial reconstruction), B (coronal reconstruction) and C (sagittal reconstruction) demonstrate a well-circumscribed lesion around 4 cm in diameter, with thin, smooth walls, predominantly of fluid attenuation inside (12 HU) in the left upper lobe. D (axial reconstruction), E (coronal reconstruction) and F (sagittal reconstruction) show a cavitary lesion around 5 cm in diameter with thickened irregular walls, dense content inside and the air crescent sign (moon sign and meniscus sign) in the left lower lobe anteromedial segment. G (axial reconstruction, parenchymal window) and H (axial reconstruction, mediastinal window) show a 5-cm thin-walled cavity communicated with the airway with lobulated air–soft tissue interface (small air bubbles within the perforated pulmonary cysts – ‘air bubble’ sign, white arrow) in the right lower lobe posterolateral segment. (I) CT shows a defect in the right and left diaphragm with herniation of retroperitoneal fat tissue into the thorax (black arrows).

Figure 3

Colony of Aspergillus niger (black colonies) and Candida albicans (white colonies) on Sabouraud-Dextrose-Agar sputum culture.
Colony of Aspergillus niger (black colonies) and Candida albicans (white colonies) on Sabouraud-Dextrose-Agar sputum culture.

Figure 4

A follow-up CT (3 months later) shows the upper left lobe cyst (A, B) unchanged in size, borders and density (2–3 HU). A reduction in size of the right (C, D) and left (E, F) lower lobes cysts with an increased density of the inside content (30–60 HU) was observed. Note the presence of ‘air bubble’ sign in both lower lobe cysts (D, E).
A follow-up CT (3 months later) shows the upper left lobe cyst (A, B) unchanged in size, borders and density (2–3 HU). A reduction in size of the right (C, D) and left (E, F) lower lobes cysts with an increased density of the inside content (30–60 HU) was observed. Note the presence of ‘air bubble’ sign in both lower lobe cysts (D, E).

Figure 5

A: Posteroanterior chest radiography shows a pulmonary mass (round dense opacity) in the left lower field (black arrow), surrounded by ill-defined left paracardiac and perihilar opacity (note the air bronchogram and silhouette signs proving consolidation) and elevation of the left hemidiaphragm. A round ill-defined heterogeneous opacity (white arrows) on the right side was found. B: Five days later, chest radiography shows partial resolution of pulmonary infiltrates on the left side with persistence of the pulmonary masses in both lower lung fields (arrows). C: A follow-up radiography after 10 days of antibacterial treatment shows a progressive decrease in the intensity of the left basal opacity and persistence of the previous cysts in the right and left lower lobes (arrows).
A: Posteroanterior chest radiography shows a pulmonary mass (round dense opacity) in the left lower field (black arrow), surrounded by ill-defined left paracardiac and perihilar opacity (note the air bronchogram and silhouette signs proving consolidation) and elevation of the left hemidiaphragm. A round ill-defined heterogeneous opacity (white arrows) on the right side was found. B: Five days later, chest radiography shows partial resolution of pulmonary infiltrates on the left side with persistence of the pulmonary masses in both lower lung fields (arrows). C: A follow-up radiography after 10 days of antibacterial treatment shows a progressive decrease in the intensity of the left basal opacity and persistence of the previous cysts in the right and left lower lobes (arrows).

Figure 6

(A) Posteroanterior (PA) chest radiography shows increase in size and intensity of the left lower lobe mass, and change in shape and size of the right lower lobe mass surrounded by less intense opacity. (B) Lateral chest radiography identified the left upper lobe cyst (not visible on PA view) with small air foci suggestive for a ruptured cyst (arrow). (C) Three-layered sputum sample (a purulent sediment, clear middle liquid and a top foamy layer).
(A) Posteroanterior (PA) chest radiography shows increase in size and intensity of the left lower lobe mass, and change in shape and size of the right lower lobe mass surrounded by less intense opacity. (B) Lateral chest radiography identified the left upper lobe cyst (not visible on PA view) with small air foci suggestive for a ruptured cyst (arrow). (C) Three-layered sputum sample (a purulent sediment, clear middle liquid and a top foamy layer).

Figure 7

Contrast-enhanced computed tomography shows hydatid cyst in left upper lobe (A–C, arrows) completely ruptured (‘onion peel’ sign or ‘Cumbo’ sign – the gas lining between the endocyst and pericyst has the appearance of an onion peel). Note the increase in size of the left and right lower lobes cysts with ‘air bubble’ sign in both cysts suggestive for secondary infection.
Contrast-enhanced computed tomography shows hydatid cyst in left upper lobe (A–C, arrows) completely ruptured (‘onion peel’ sign or ‘Cumbo’ sign – the gas lining between the endocyst and pericyst has the appearance of an onion peel). Note the increase in size of the left and right lower lobes cysts with ‘air bubble’ sign in both cysts suggestive for secondary infection.
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English
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Journal Subjects:
Medicine, Clinical Medicine, Clinical Medicine, other, Internal Medicine, Pneumology
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