Diagnosis and treatment of infected pulmonary hydatid cyst rupture into the pleural cavity in children

Objective: To improve the diagnostic and treatment strategy for infected pulmonary hydatid cysts complicated by rupture into the pleural cavity in pediatric patients. Material and Methods: A retrospective and prospective cohort study was conducted on 140 children with complicated, infected pulmonary hydatid cysts, where rupture into the pleural cavity was diagnosed in 37 (26.4%) patients. The main group consisted of 24 patients (managed according to the developed algorithm), and the control group consisted of 13 patients (managed according to traditional methods). The study utilized general clinical, laboratory, radiographic, computed tomography (CT), bacteriological, histological, and statistical research methods. Results: CT verified cyst rupture in 86.4% of cases. The developed algorithm includes comprehensive preoperative management using minor surgical techniques (puncture and thoracentesis for sanitation and decompression). In the main group, reliable stabilization of hematological parameters (decrease in leukocytes to 7.40±0.25 x10⁹/L), relief of endotoxicosis (mean survival time of Paramecium was 39.2±1.0 sec), and attenuation of systemic inflammatory response (LII 1.5±0.1 units) were achieved. Organ-preserving surgeries (echinococcectomy with subtotal pericystectomy) yielded good results in 66.9% of patients and satisfactory results in 33.1%. Conclusions: Based on the identified clinical and morphological features, a diagnostic and treatment algorithm is proposed that enables early diagnosis, effective resolution of severe toxemia manifestations, and a differentiated approach to surgical intervention, thereby minimizing postoperative complications.

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