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

• Published in: BMC infectious diseases Vol. 23; no. 1; p. 229
• Main Authors: Schneider, Anne, Klengel, Steffen, Lübbert, Christoph, Trawinski, Henning
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.04.2023; BioMed Central; BMC
• Subjects: Abdomen; Albendazole; Alveolar; Alveoli; Analysis; Antiparasitic agents; Asymptomatic; Bacterial infections; Biopsy; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - diagnosis; Care and treatment; Case Report; Case reports; Chylothorax; Complications and side effects; Computed tomography; CT imaging; Cysts; Diaphragm; Diaphragm (Anatomy); Diaphragm - pathology; Dyspnea; Echinococcosis; Echinococcosis, Hepatic - complications; Echinococcosis, Hepatic - diagnosis; Echinococcosis, Hepatic - pathology; Echinococcus multilocularis; Female; Fox tapeworm; Glucose; Hepatocellular carcinoma; Humans; Infectious diseases; Infiltration; Liver; Liver Neoplasms - complications; Liver Neoplasms - diagnosis; Lungs; Magnetic resonance imaging; Malignancy; Medical imaging; Metabolism; Middle Aged; Necrosis; Patients; PET imaging; Pleura; Pleura - pathology; Pleural effusion; Positron emission; Positron emission tomography; Prevention; Respiration; Risk factors; Serology; Spleen; Weight loss; Zoonoses; Germany; Europe; China; Echinococcus multilocularis; Alveolar; Fox tapeworm; Pleura; chylothorax; Echinococcosis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-023-08180-5

Alveolar echinococcosis (AE) is an endemic parasitic zoonosis in Germany. In most cases, the liver is the primary organ affected. 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. 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.