International Surgery Journal | June 2021 | Vol 8 | Issue 6 Page 1910 International Surgery Journal Gupta K et al. Int Surg J. 2021 Jun;8(6):1910-1912 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Intraoperative transthoracic ultrasonography in hepatopulmonary hydatid cyst disease: seeing beyond the horizon Komal Gupta, Ankita Singh, Deepti Singh, Gopal Puri, Pritam Yadav, Kamal Kataria* INTRODUCTION Hydatid disease caused by Echinococcus granulosus is one of the commonest zoonosis, with humans as accidental intermediate host. It primarily affects liver. However, hepato-pulmonary involvement is well established in 4-25% cases. 1 Currently surgical management is the only treatment available with curative intent. Open approach is preferred in cases of ruptured hydatid cyst. Here we have emphasized the advantage of using intra operative transdiaphragmatic ultrasonography for localization and drainage of hepatic cysts. CASE REPORT A 22 years old lady presented with complaint of a single episode of sudden onset severe upper abdominal pain 1 month prior. It was self-resolving. There was no history of lump in the abdomen, jaundice, breathing difficulty. With clinically palpable non tender hepatomegaly, on further evaluation patient was found to have eosinophilia and a unilocular cystic lesion was identified in the liver on ultrasound. Chest X ray showed an opaque space occupying lesion in the lower lobe of the right lung. On contrast enhanced computed tomography (CECT) of chest and abdomen, a large thin walled unilocular cystic lesion measuring 12×10 cm in right lung lower lobe and another cyst measuring 8×8 cm in segment VII of the liver likely due to hydatid cyst disease were identified (Figure 1). Patient was started on oral albendazole tablets. She was scheduled to undergo drainage/excision of the pericysts by thoracoabdominal approach. However, while awaiting elective surgery, patient had multiple episodes of vomiting and dyspnoea. Chest X ray suggested rupture of the right lung hydatid cyst (Figure 2). There was no airway or hemodynamic compromise. Patient was taken to operation theatre for an emergency right posterolateral thoracotomy. Intraoperatively ruptured hydatid cyst was found with spillage of detached membrane and fluid in the right pleural cavity. Thoracic cavity was packed with surgical pads soaked in scolicidal agent (povidone iodine). Hydatid membrane was evacuated, along with daughter cysts and pleural cavity was lavaged with scolicidal agent. Areas of air leaks into the pericyst ABSTRACT Liver is the most common organ involved in hydatid disease. But involvement of multiple organs simultaneously is not unheard of. Here we have presented our experience with one such similar case with involvement of lower lobe of right lung and segment VII of liver. There was spontaneous rupture of the lung hydatid cyst during the hospital stay. A right posterolateral thoracotomy was performed for evacuation of spilled hydatid cyst content from the right pleural cavity. Intraoperative ultrasound (IOUS) was used to locate and drain the hepatic hydatid cyst via the diaphragm. Such single incision surgery for hepatopulmonary hydatid disease is associated with lesser post-operative morbidity and early discharge from the hospital. Use of IOUS can significantly improve the rate of successful localization and drainage of hepatic hydatid cyst in transthoracic approach. Keywords: Intraoperative ultrasound, IOUS, Hydatid disease, Liver surgery, PAIR, Thoracotomy Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India Received: 27 March 2021 Accepted: 07 May 2021 *Correspondence: Dr. Kamal Kataria, E-mail: drkamalkataria@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20212290