Mediastinal hydatic cysts: an uncommon cause of mediastinal enlargement.

A 32-year-old man was referred with complaints of progressive dysphagia for 1 month, postprandial fullness, abdominal pain/distension, cough and dyspnea. Physical examination revealed hepatosplenomegaly with multiple painless abdominal masses in the right upper quadrant, but no ascites or edema. Chest auscultation revealed normal breath sounds. Laboratory studies showed eosinophilia 12%, aspartate aminotransferase 81 U/l, alanine aminotransferase 60 U/l, alkaline phosphatase 238 IU/l, -glutamyl transpeptidase 183 U/l, total bilirubin 1.9 mg/ dl, direct bilirubin 0.6 mg/dl, indirect bilirubin 1.3 mg/ dl, and HIV I/II antibody negativity. An enzyme-linked immunosorbent assay to evaluate immunoglobulin G and a fluoroenzyme immunoassay to evaluate immunoglobulin E were positive, and antibodies to Echinococcus granulosus (titer 1: 512) were detected. Chest radiography showed multilobulated mediastinal enlargement, rounded abdominal calcifications and normal pulmonary parenchyma ( fig. 1 ). Contrast-enhanced abdominal and thoracic computed tomography revealed multiple large cysts in the liver and spleen, some with calcified walls ( fig. 2 a), extending into the mediastinum and displacing the heart anteriorly ( fig. 2 b). The Published online: December 5, 2012