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1. In our case, iatrogenic cyst rupture triggered the development of an eosinophilic pleurisy.
The definition of eosinophillic pleurisy can be seen below;
Reactive eosinophilic pleuritis: a lesion to be distinguished from pulmonary eosinophilic granuloma....
Reactive eosinophilic pleuritis: a lesion to be distinguished from pulmonary eosinophilic granuloma.
Askin FB, McCann BG, Kuhn C. Arch Pathol Lab Med 1977;101:187-91
Pleural nodules or sheets of histiocytes, admixed with eosinophils, giant cells, and other inflammatory cells are observed frequently in patients with spontaneous pneumothorax. This reaction, designated reactive eosinophillic pleuritis (REP), can closely resemble eosinophilic granuloma. Reactive eosinophilic pleuritis was found in pleural tissue of 22 of 57 patients with spontaneous pneumothorax in whom tissue was available for study. None of these patients had clinical or radiographic evidence of interstitial lung disease. Follow-up of 20 patients with REP ranged from six months to five years. None developed evidence of eosinophilic granuloma. Electron microscopy of one case did not show the Langerhans granules characteristic of the histiocytoses, including eosinophilic granuloma. Reactive eosinophilic pleuritit appears to be a nonspecific reaction to pleural injury, and is not a prodromal feature of pulmonary eosinophilic granuloma.
Authors did not present any biposy evidence yet claimed Eosinophilic Pleurisy.
2. Eosinophilia is found in less than 15% of patients and is generally only present following leakage of antigen from cysts. Without leakage too eosinophil count is rarely normal. One needs care count not eosiniphillia.
3. Figure 1, One view appears from surface plane and other through mid plane of cyst. To say non-cystic hydatid cyst is a neo-proposition perfectly indigestible.
4. A liver ultrasound scan detected a 35 mm lesion in the right lobe of the liver and at this point we proceeded to analyse hydatid serology. Was it an UltraSound for lung now and liver in next round and abdomen after some time and pelis after next time. Sophisticated instrument in hand, patient on table, procedure safe, facilities plenty becuse England: what could be harm to see all soft organs at one sitting particularly suspecting malignancy or paracytic cysts. How a liver cyst should be pathognomonic of hydatid while in lung it was diagnostic of malignancy on USG.
5. Complication could be avoided if Serology earlier or first.
How one can go to serology first if no suspicion of Hydatid. Should serology for hydatid be advisable for all the cases suspected carcinoma as in this case.
Hypotheses, hence, are lacking support for validity or reason.