We read with great interest the comprehensive Review by Kerstin Wahlers and colleagues on cystic echinococcosis in sub-Saharan Africa. The investigators declared that some patients with hydatid cyst might have been overlooked or misdiagnosed because of limitations of the diagnostic techniques. The researchers referred to ultrasonography as a method unable to diagnose cases of pulmonary hydatid cyst. Although ultrasonography is used routinely for diagnosis of hepatic cystic echinococcosis, a few indications for ultrasound in the detection of pulmonary hydatid cysts also exist. In patients with peripheral pulmonary opacities with horizontal line (air-fluid level), ultrasound could be used to diagnose lung abscesses and masses associated with fluid and consolidation. This scan could be done in patients in a sitting or semi-sitting position. Therefore, ultrasonographic examination might provide proper imaging of pulmonary hydatid cysts adjacent to the chest wall. Furthermore, ultrasonography is of great assistance in clinically suspicious cases, and the data needed for precise diagnosis could be provided by this method.4 Additionally, specific ultrasonographic markers (eg, double-layered internal septum) have been suggested to be highly specific in the diagnosis of pulmonary echinococcal cysts.
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