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Letters to the Editor Indian Pediatrics 2002; 39:1062-1063 |
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Hydatid Disease of Lungs – Unusual Cause of Hemoptysis |
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Hemoptysis is one of the most frightening manifestations of cardiopulmonary disease. A wide spectrum of diseases have been reported to cause hemoptysis in children but the search for a specific cause can be tedious and unrewarding(1). We report an unusual cause of hemoptysis in children i.e. pulmonary hydatidosis. A six year old girl, resident of District Shimla in Himachal Pradesh was brought to us with complaints of two episodes of hemoptysis a week before presentation. Blood was bright red, small in quantity (5-10 mL) following mild bouts of cough. There was no history of fever, chest pain, respiratory distress, cyanosis, chest trauma, foreign body inhalation or contact with a case of tuberculosis. There was a history of exposure to domestic animals including dogs, cows and sheep. Examination revealed mild pallor and insignificant lymphadenopathy. There was no respiratory distress. Bronchial breathing was present along with occasional crepitations in the left infrascapular area. Liver was palpable 8 cm below right costal margin with firm consistency. Chest radiograph showed two round homogenous densities almost covering half of the left lung. Ultrasonography revealed four cysts in the right lobe and two in the left lobe of liver. Cysts were thick walled and clear without any daughter cysts. The maximum diameter of the cyst was 8.8 cm. She was started on albendazole and subsequently referred to tertiary care center for further surgical management. Hemoptysis in adults is most often caused by tuberculosis, bronchitis, bronchiectasis, trauma or bronchogenic carcinoma. Pediatric hemoptysis is most likely to be secondary to infection, tracheostomy related problem or foreign body aspiration. Other causes include congenital heart disease, pulmonary hemosiderosis, cystic fibrosis, trauma or fictitious hemoptysis(1). However parasitic etiology i.e. cystic echinococcosis has not been implicated as a cause in most of the series on hemoptysis in children. This could be attributed to the origin of most of these series from the geographical areas nonendemic for cystic hydatid disease. Our patient belonged to a hamlet in Himachal Pradesh where hydatid disease is fairly common as people of hilly areas use sheep for wool for their domestic use as "pattus" and "pattis"(2). Liver and lung are the two common sites of involvement in hydatid disease; concomitant involvement of both may be noticed in 10% of the cases. Some of the series in children report higher incidence of pulmonary hydatidosis(3). Most of the children have involvement of the right lung and the lower lobes more frequently involved. However our patient had left lung involvement with both upper as well as lower lobes. Small cysts are usually asymptomatic and may be an incidental finding. Cough, chest pain, breathlessness are the common presenting symptoms. Hemoptysis as a presenting sysmptom is common in adult series (upto 70%) but rare in childhood series. The incidence of hemoptysis in children may be none to as high as 38% in one series by Solak et al.(4). In another study on childhood echinococcosis from Delhi, none had hemoptysis as the presenting feature(5) but in a report of 16 cases from Madurai one child developed hemoptysis two years after the detection of pulmonary hydatid disease(6). The mechanism of hemoptysis may be due to pressure erosion of a bronchus or a obstructive effect with bronchial infection. There may be occasional rupture of cyst into the bronchus resulting in massive hemoptysis. The diagnosis in our patient is only clinical-radiological and not supported by serology, histopathology or therapeutic response to albendazole. Underlying etiology for hemoptysis may be unknown in 20% of the cases, but in cases with pulmonary hydatidosis clinical and radiological picture is so unique that it can be easily picked up despite its rarity. Sahul Bharti, Bhavneet Bharti, Civil Hospital, Rohroo, District Shimla, Himachal Pradesh, E-mail: [email protected] |
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