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Others result from rupture of a primary pulmonary hydatid into the bronchial tree with bronchogenic spread, or into a pulmonary blood vessel with metastatic spread. Multiple lung cysts are not uncommon (Figs. 3.85 & 3.86). True daughter cysts are rare in the lung, because they usually develop only if a cyst becomes traumatized or infected, and a hydatid cyst in the lung is relatively protected from trauma.

As many as 16% of pulmonary hydatids are reported to be accompanied by concurrent liver cysts, but associated cysts within the mediastinum, pleura, rib cage, thoracic spine, and breast are uncommon. Involvement of the lung without hydatid disease in the liver may be due to inhalation of eggs excreted by the primary host, usually the dog. Eggs are quite resistant to drying and, because of their small size, could be carried in the wind. Direct entry of oncospheres into lymphatics rather than into the portal vein can also account for bypassing the liver.

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Fig. 3.85 Multiple hydatid cysts of the lungs. (A) PA and (B) lateral views of the chest show two large, slightly lobular, round masses in the left lower lobe. The mass in the superior segment of the left lower lobe is partially concealed by the left heart border in the frontal projection, but the lateral view clearly shows the two discrete masses. (C) There are two separate hydatid cysts in the right lung base partially superimposed on each other and obscuring the right hemidiaphragm of an African patient. There is a small right pleural effusion. (D) Two discrete round hydatids are present in the upper lobes of another patient.

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Fig. 3.86 Multiple hydatid lung cysts in three patients. (A) There are two large oval hydatids in the midportions of both lungs, giving a bizarre appearance to the chest on frontal view. There is another hydatid at the left base which has ruptured and contains air and there are multiple small nodular and cavitary densities in the right upper lobe, which could be small metastatic hydatid implants or tuberculosis. The patient was an Inca Indian from the Andes Mountains of Peru. (B) Two hydatid cysts are present in the right upper lobe and suprahilar area of another man, and are partially superimposed on each other. (C) There is a large hydatid cyst occupying much of the right lower hemithorax with other smaller hydatids in the left perihilar area. (D) Autopsy specimens of multiple E. granulosus cysts of lung and liver. AFIP 57- 15836-2.

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