Mikrorüptüre Kist Hidatik Kaynaklı Pulmoner Parazitik Embolizasyon: Bir Otopsi Olgusu

Abstract

Ekinokokkoz genellikle uzun yıllar boyunca asemptomatik kalmakla birlikte kist rüptürü, süperenfeksiyon gibi komplikasyonlar nedeniyle ölüme de neden olabilmektedir. Makroskobik olarak non-rüptüre kiste bağlı ölüm oldukça nadir olup mekanizması tam olarak bilinmemektedir. Literatürde otopsi ile tanı konulan benzer özellikte birkaç olgu bildirilmektedir. Bu otopsi olgusunda hidatik kist mikrorüptürüne bağlı olduğu değerlendirilen ölüm sunulmaktadır. Karaciğerinde rüptüre olmayan kist saptanan cesetin akciğerinin mikroskopik incelemesinde yaygın intraalveolar kanama, ödem, ağır hiperemi, interstisyel kapiller lümenlerinde nötrofil stazı, kapiller lümeninde çok sayıda parazit varlığı saptandı. Ölüm nedeninin intakt karaciğer kistlerinden kan dolaşımına sızan kist içeriğine karşı gelişen anaflaksi ve nontrombotik akciğer embolizasyonu sonucu geliştiği düşünülmüştür. Ekinokokkozun endemik olduğu ülkelerde tüm anaflaksi ve ani ölüm olgularında ayırıcı tanıda ekinokokkoz düşünülmesi gerekmektedir.

Keywords

• Anafilaksi
• echinococcus
• karaciğer
• parazitemi
• ani ölüm

Pulmonary Parasitic Embolization Caused by Micro Ruptured Hydatid Cyst: An Autopsy Case

Abstract

Echinococcosis generally remains asymptomatic for many years, but it can also be fatal if complications like cyst rupture or superinfection occur. It is highly uncommon for a macroscopically non-ruptured cyst to cause death, and its exact mechanism is unknown. In the literature, there are several cases with identical characteristics diagnosed by autopsy. This autopsy case has illustrated the death due to a micro ruptured hydatid cyst. The deceased's lung underwent microscopic inspection, and it revealed broad intraalveolar hemorrhage, edema, severe hyperemia, neutrophil stasis in the interstitial capillary lumens, and a large number of parasites in the capillary lumen. Anaphylaxis against cyst contents that leaked into the bloodstream from liver cysts and non-thrombotic pulmonary embolization were shown to be the causes of mortality. In countries where echinococcosis is endemic, echinococcosis should be considered in all cases of anaphylaxis and sudden death.

Keywords

• Anaphylaxis
• echinococcus
• liver
• parasitemia
• sudden death

References

1. Galeh TM, Spotin A, Mahami-Oskouei M, Carmena D, Rahimi MT, Barac A, et al. The seroprevalence rate and population genetic structure of human cystic echinococcosis in the Middle East: A systematic review and meta-analysis. Int J Surg. 2018;51:39-48.
2. Georgiou GK, Lianos GD, Lazaros A, Harissis HV, Mangano A, Dionigi G, et al. Surgical management of hydatid liver disease. Int J Surg. 2015;20:118-22.
3. Büyük Y, Turan AA, Uzün I, Aybar Y, Cin O, Kurnaz G. Non-ruptured hydatid cyst can lead to death by spread of cyst content into bloodstream: an autopsy case. Eur J Gastroenterol Hepatol. 2005;17(6):671-3.
4. Zaimi S, Bellamlih H, Nassar I. Hydatid pulmonary embolism: An exceptional complication of hydatid disease. Radiol Case Rep. 2020;15(5):545-7.
5. Thameur H, Abdelmoula S, Chenik S, Bey M, Ziadi M, Mestiri T, et al. Cardiopericardial hydatid cysts. World J Surg. 2001;25(1):58-67.
6. Ben Khelil M, Allouche M, Banasr A, Gloulou F, Benzarti A, Zhioua M, et al. Sudden death due to hydatid disease: a six-year study in the northern part of Tunisia. J Forensic Sci. 2013;58(5):1163-70.
7. Jedidi M, Mlayeh S, Masmoudi T, Souguir MK, Zemni M. Sudden death due to hydatid cyst: thirty-four medicolegal autopsy cases. Am J Forensic Med Pathol. 2014;35(1):29-33.
8. Ben Jomaa S, Haj Salem N, Hmila I, Saadi S, Aissaoui A, Belhadj M, et al. Sudden death and hydatid cyst: A medicolegal study. Leg Med (Tokyo). 2019;40:17-21.

9. Byard RW. An analysis of possible mechanisms of unexpected death occurring in hydatid disease (echinococcosis). J Forensic Sci. 2009;54(4):919-22.
10. Dursun M, Terzibasioglu E, Yilmaz R, Cekrezi B, Olgar S, Nisli K, et al. Cardiac hydatid disease: CT and MRI findings. AJR Am J Roentgenol. 2008;190(1):226-32.
11. Unal E, Balci S, Atceken Z, Akpinar E, Ariyurek OM. Nonthrombotic pulmonary artery embolism: imaging findings and review of the literature. AJR Am J Roentgenol. 2017;208(3):505-16.
12. Şahpaz A, İrez A, Gülbeyaz H, Şener MT, Kök AN. Non-thrombotic pulmonary embolism due to liver hydatic cyst: a case report. Balkan Med J. 2017;34(3):275-7.
13. Gelincik A, Ozşeker F, Büyüköztürk S, Colakoğlu B, Dal M, Alper A. Recurrent anaphylaxis due to non-ruptured hepatic hydatid cysts. Int Arch Allergy Immunol. 2007;143(4):296-8.
14. Kıraç CO, Uçar R, Arslan Ş, Taşcı Hİ, Çalışkaner AZ. Recurrent anaphylaxis: an unruptured splenic hydatid cyst as an unusual cause. Asthma Allergy Immunol. 2016;14(2):103-6.
15. Hosseini M, Hedjazi A, Bahrami R. Sudden death due to anaphylactic shock in a patient with an intact hepatic hydatid cyst. Am J Forensic Med Pathol. 2014;35(4):256-7.
16. Sanei B, Hashemi SM, Mahmoudieh M. Anaphylactic shock caused by nonruptured hydatid cyst of the liver. J Gastrointest Surg. 2008;12(12):2243-5.
17. Apitzsch JC, Westphal S, Penzkofer T, Kuhl CK, Knüchel R, Mahnken AH. The use of contrast-enhanced post Mortem CT in the detection of cardiovascular deaths. PLoS One. 2014;9(4):e93101.
18. Nishio H, Takai S, Miyazaki M, Horiuchi H, Osawa M, Uemura K, et al. Usefulness of serum mast cell-specific chymase levels for postmortem diagnosis of anaphylaxis. Int J Legal Med. 2005;119(6):331-4.
19. Trani N, Bonetti LR, Gualandri G, Barbolini G. Immediate anaphylactic death following antibiotics injection: splenic eosinophilia easily revealed by pagoda red stain. Forensic Sci Int. 2008;181(1-3):21-5.
20. Meyer PG, Bonneville C, Orliaguet GA, Dessemme P, Blakime P, Carli PA, et al. Grand mal seizures: an unusual and puzzling primary presentation of ruptured hepatic hydatid cyst. Paediatr Anaesth. 2006;16(6):676-9.