Simultaneous Percutaneous Alcohol Ablation of Pulmonary and Hepatic Hydatid Cysts: “PAIR” in a Pair

Hydatid disease is caused by the larval forms of the cestode, Echinococcus granulosus where man is the intermediate host.1 Hydatid disease is a zoonotic disease that is known to occur worldwide.2 The highest prevalence of human hydatid disease in India has been reported from Andhra Pradesh, Saurashtra, and Tamil Nadu.3 Most commonly affected organs are the liver ( 75%) and lungs ( 15%).4 It is a major health problem with significant morbidity if left untreated. Lungs act as a second filter for the hydatid cysts in the human body and thus the secondmost common involved site.4 Various treatment options exist, ranging from pharmacological management to surgical resection. For pulmonary hydatid cysts, surgery is considered as first-line treatment with lung-preserving surgeries such as enucleation, pericystectomy, cystectomy or cystostomy with or without capitonnage being the options.5,6 Due to significant morbidity associated with surgery, there is an upsurge in minimally invasive surgical techniques such as thoracoscopic removal of the cysts located subpleurally.7 These techniques have been manipulated as an adjunct to the medical treatment.7,8 There are a few reports in the indexed literature stating the feasibility of thoracoscopic instillation of scolicidal agents especially hypertonic saline.7 Also, there are also stray anecdotal reports of percutaneous injection of scolicidal agents into the pulmonary hydatid cyst. However, PAIR technique has been extensively used and is now considered as a well-established treatment option in appropriate cases of hepatic hydatid cysts. Encouraged by the results of PAIR in hepatic cysts and coupled with the fact that thepulmonarycyst inourcasewasabutting the chestwall and had a very easy access, we attempted PAIR-D (percutaneous aspiration, instillation of scolicidal agents, reaspiration of contents, and drainage) in the pulmonary cyst and a needlePAIR in hepatic cyst in the same sitting. A written informed consent from the patient and clearance from the institutional review board was obtained before the procedure.