Clinical and radiological presentations of pulmonary hydatid cysts in Yemen: a retrospective cross-sectional study at a tertiary center

BACKGROUND: Pulmonary hydatid cysts caused by Echinococcus granulosus represent a significant health burden in endemic regions such as Yemen. Limited contemporary data are available on the clinical and radiological characteristics of this disease in the Yemeni population. This study aimed to evaluate the clinical presentation, radiological features, surgical management, and early outcomes of pulmonary hydatid cysts at a tertiary center in Sana'a, Yemen. METHODS: This retrospective cross-sectional study was conducted at Al-Thawra Modern General Hospital between January 2019 and March 2023. The medical records of 114 patients with surgically confirmed pulmonary hydatid cysts were analyzed. Demographic data, clinical presentation, radiological findings, surgical procedures, and early postoperative complications were collected using structured questionnaires. Statistical analyses were performed using SPSS v. 28.0, and 95% confidence intervals were calculated for all the proportions. RESULTS: Of the 114 patients, 82 (71.9%; 95% CI: 63.1%-79.4%) were male, with a predominant age group of 19-30 years (43.0%; 95% CI: 34.3%-52.2%). Most patients were from urban areas (75.4%; 95% CI: 66.8%-82.4%) and worked as laborers (35.1%) or students (33.3%). Khat chewing was reported by 50.0% (95% CI: 41.0%-59.0%) of the patients. Five patients (4.4%; 95% CI: 1.9%-9.8%) were asymptomatic. The most common symptoms were cough (89.5%; 95% CI: 82.5%-93.9%), dyspnea (76.3%; 95% CI: 67.7%-83.2%), chest pain (64.9%; 95% CI: 55.8%-73.1%), and sputum production (71.1%; 95% CI: 62.2%-78.6%). Radiologically, 97 patients (85.1%; 95% CI: 77.4%-90.5%) had solitary cysts, predominantly in the right lung (67.0%). Most cysts were intact (76.3%; 95% CI: 66.9%-83.6%). Among the 17 patients with multiple cysts, 36 individual cysts were identified (range: 2-4 per patient). Twelve patients (10.5%; 95% CI: 6.0%-17.4%) had concurrent liver hydatid cysts documented on preoperative imaging. Among solitary cysts, peri-cyst changes, including mass effect (39.2%), empyema (5.2%), and pleural effusion (2.1%), were documented. Preoperative albendazole was administered to 8.8% of patients, and 95.6% underwent elective surgery. Capitonnage was performed in 91.2% (95% CI: 84.6%-95.2%) of the cases. Postoperative complications occurred in 7.9% (95% CI: 4.2%-14.3%), with no mortality reported. Hospital stay was less than 1 week for 75.4% (95% CI: 66.8%-82.4%) of patients. CONCLUSIONS: Pulmonary hydatid cysts in Yemen predominantly affect young urban males and present with respiratory symptoms. Solitary, intact cysts are the most common, and surgical management with capitonnage is safe and effective, with low morbidity rates when performed in specialized centers.