The Journal of Association of Chest Physicians

: 2015  |  Volume : 3  |  Issue : 2  |  Page : 77-

Pulmonary hydatid cyst presenting as massive unilateral pleural effusion

Motilal Bunkar, Rajendra Takhar, Savita Arya 
 Department of Respiratory medicine, Govt. Medical College, Kota, Rajasthan, India

Correspondence Address:
Rajendra Takhar
Department of Respiratory Medicine, Qtr. No: 1/4, Govt. Medical College Campus, Kota - 324 010, Rajasthan

How to cite this article:
Bunkar M, Takhar R, Arya S. Pulmonary hydatid cyst presenting as massive unilateral pleural effusion.J Assoc Chest Physicians 2015;3:77-77

How to cite this URL:
Bunkar M, Takhar R, Arya S. Pulmonary hydatid cyst presenting as massive unilateral pleural effusion. J Assoc Chest Physicians [serial online] 2015 [cited 2022 Dec 6 ];3:77-77
Available from:

Full Text

Dear Sir,

We read the nicely written article, "Pulmonary hydatid cyst presenting as massive unilateral pleural effusion" by Chakrabarti et al. published in your prestigious journal with great interest. [1]

First of all, we would like to congratulate the authors for illuminating us with this topic of huge clinical importance, pulmonary hydatid and about its unusual or unique presentations. Even though, the authors have presented the case in a simple, lucid, elaborative and elegant way yet human brain is accustomed to ask certain fallacies to our best of the abilities.

We would like to know; why the left side of the hemi thorax had marked limitation/abnormality during respiratory system examination, e.g., diminished movement, dull percussion note, almost absent breath sounds and diminished vocal resonance. Furthermore, authors have mentioned about shifting of trachea and heart toward side right. As with the best of our knowledge all these findings will be only present when the patient had ipsilateral pleural effusion not in contra-lateral pleural effusion as described in the article. Along with these clinical findings, decreased tactile fremitus, and asymmetrical chest expansion, with diminished or delayed expansion are present on ipsilateral side of the effusion [2],[3]We have also seen clinico-radiological disparity in this article. Clinico-radiological discrepancy is defined as a difference in opinion between the original interpretation of clinical examination and its interpretation with radiology, which may affect patient diagnosis and further outcome. [4] As in presented case, clinical examinations supporting left sided pathology but radiological images are suggestive of right sided pleural effusionAuthors have also described "General physical examination was within the normal limits and shifting of the trachea to right side." How it can be possible when both findings are contradictory to each other.

It is our humble request not to argue, but to discuss common fallacies during clinical examination and their correlation with radiology. We want to bring author's notice to these minute details which do have a significant role in our day care medical practices. Furthermore, we also want to introduce the well-defined term "clinico-radiological disparity" and its importance, here in the context of this article.


1Chakrabarti S, Patra A, Biswas P, Mandal K. Pulmonary hydatid cyst presenting as massive unilateral pleural effusion. J Assoc Chest Physicians 2015;3:20-2.
2Kalantri S, Joshi R, Lokhande T, Singh A, Morgan M, Colford JM Jr, et al. Accuracy and reliability of physical signs in the diagnosis of pleural effusion. Respir Med 2007;101:431-8.
3Wong CL, Holroyd-Leduc J, Straus SE. Does this patient have a pleural effusion? JAMA 2009;301:309-17.
4Fitzgerald R. Error in radiology. Clin Radiol 2001;56:938-46.