A 56-year-old male patient, farmer throughout his working life, presented the following background:
• Thoracic contusion, in April 2013, after falling from a height of about 3 meters, with chest X-ray without significant changes.
• Follow-up in the rheumatology consultation due to polyarthralgia with SGA within normal limits, and family history of rheumatic polymyalgia; finally discharged in November 2014 with probable CT diagnosis of poliar fracture.
• Assessed in internal medicine consultation to detect slightly elevated Ca-125; has a family history of colon carcinoma and liver carcinoma.
Colonoscopy in 2012 was normal.
Abdominal ultrasound (July 2013): mild hepatic steatosis.
Mayor in March 2014.
The patient came to Primary Care due to persistent dry cough after completing one week of antibiotic treatment prescribed for a picture compatible with acute bronchitis.
He has no history of smoking, respiratory disease or known contact with tuberculosis; he has two dogs as domestic animals.
On physical examination, the pulse oximeter showed a saturation of 95 %, and on cardiopulmonary auscultation, right basal hypoventilation was observed, with no other significant alterations.
A preferential chest X-ray was requested from Primary Care on 04/14/15.
The patient came to collect the result on April 20.
In view of the multiple rounded lesions of large size, the emergency service of the General Hospital of Villarroble was contacted by telephone, requesting TAC, both of which were performed on the day after the intravenous contrast agent.
At the same time, they contact the Department of Pulmonology, which performs a Pneumology Ward that same day and cites a fibrobronchoscopy in less than a week (April 27).
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• Result of abdominal CAT scan with intravenous contrast : cystic masses of 67 and 75 mm of unilocular diameter polylobulated in the right lower lobe; as first possibility pulmonary hydatid disease.
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• Analytical: Normal basic biochemistry, including liver profile.
Normal blood count.
PCR 9 mg/L, VSG 8 mm/h.
High Ca-125 (124.8 U/mL), other negative tumor markers.
Brucella serology: IgG 29.5 g/L; negative bengala pink; negative IgM.
Serology had negative Echinoccocus.
Serology Leishmania, Lues, HBV, HCV and HIV negative.
• Respiratory functional tests: FEV1 2660 L (94.6 %), FVC 3690 L (105 %), DLCO 87.5 %.
Positive bronchodilator test.
• Fibrobronchoscopy: No endobronchial lesions in both bronchial trees.
Along with this point, the differential diagnosis is proposed with: primary pulmonary carcinoma, the latter being the most frequent cause; pulmonary abscess; tuberculosis; hyptid disease; minor lung disease-related lymphangiosis; also, interstitial lung abscess;
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The patient is usually admitted to the thoracic surgery service.
It's seen May 5, 2015 and it's offered surgery the next day.
The cystectomy was compatible with hydatid cyst.
Treatment with albendazole was initiated for 4 weeks.
The patient is currently being followed up in the Pneumology and Thoracic Surgery Departments.
Pathology confirmed the diagnosis of pulmonary hydatid disease.
