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Thorax

Lungs

Intact hydatid cysts of the lungs are commonly solitary, well-circumscribed, homogeneous, uncalcified masses. They are usually round but may be oval, elliptical or lobulated (Figs. 3.83-3.91). They can occur anywhere in the lungs, but are somewhat more common on the right side and in the basilar segments of both lower lobes. The majority of such cysts arise de novo within the lungs. Secondary cysts, which have spread through the diaphragm from the liver, can occur.

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Fig. 3.83 Large solitary hydatid cyst of the lung in two different patients from Spain. When intact, pulmonary hydatids are usually solitary, well-circumscribed, homogeneous masses. They are usually round but may be oval, elliptical or lobulated in contour. (A and B) PA and lateral views of the chest showing a lobulated, elliptical, homogeneous mass in the right upper lobe. There is umbilication or notching along the medial and posterior borders of this hydatid (arrows) caused by pressure on the cyst from adjacent vessels or bronchi. (C and D) A similar lobulated, elliptical mass in the right lower lobe of a second Spaniard. The elliptical or oval shape of some hydatids allows differentiation from benign or malignant neoplasms of the lung, which rarely show such a contour.

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Fig. 3.84 Large, solitary, unruptured pulmonary hydatid cysts in four different patients. (A) There is a huge, well circumscribed, round mass in the left lower lobe, partially concealed by the left heart border in a Peruvian Indian. (B) A large homogeneous mass in the left upper lobe of an 8-year-old child. (C and D) A smooth round mass in the right cardiophrenic angle with its medial border blending into the cardiac silhouette in a male patient from India. This was a hydatid cyst in the right middle lobe mimicking a pericardial cyst or foramen of Morgagni hernia. (E) PA chest film in moderate inspiration shows a large round opacity in the right base of another Indian man. There is apparent flattening of the right hemidiaphragm with suggestion of possible pleural disease. There is tenting of the midportion of the left hemidiaphragm. (F) Chest film of the same patient taken in deeper inspiration demonstrates a smooth, round mass in the right base. The right hemidiaphragm now appears unaffected by this mass which was an uncomplicated hydatid cyst in the right lower lobe. (C - F courtesy of Dr. A. Chandrahasan Johnson, Tulsa, Oklahoma).

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