538 THE ANIMAL PARASITES OF MAN 



In other cases the symptoms of pyopneumothoraz develop. Not rarely rup- 

 ture into the diaphragm occurs, and thus the eehinococcus finds entrance into 

 the parenchyma of the liver. Eupture into the intestine and into the walls of 

 the abdomen etc., has also been observed. Secondary pulmonary echinococci 

 are rarer than primary ones. Usually originating in the liver, they penetrate 

 the diaphragm and the pleural cavity and enter the lung. Eupture into the, 

 bronchi or into the pleural cavity produces severe symptoms. The simul- 

 taneous perforation of the biliary passages and the intestine has been repeat- 

 edly observed. 



The symptoms for a long time may be indefinite and point only to an 

 affection of the respiratory organs. With increasing growth a very trouble- 

 some cough and attacks of dyspnea usually occur. As 

 the first symptom I have repeatedly observed hemop- 

 tysis with cough, so that the clinical picture resembled 

 phthisis pulmonum. Severe paroxysms of cough may 

 cause perforation by the eehinococcus, mostly unilocu- 

 lar, into the bronchi, and the discharge of cysts, large, 

 rolled-up masses of membrane or shreds of membrane 

 and scolices. The seat of the disease, and sometimes 

 even the side which is affected by the disease, may be 

 Fig. 52.— Expectorated difficult to recognize, if the cyst is centrally situated 



EcHiNococcus Mem- . tVi.i-ii i> i j- 



3JJANE. or IS surrounded by a thick layer or pulmonary tissue 



containing air. Not rarely, prior to rupture, suppura- 

 tion or putrefaction of the contents of the cyst occurs, and this always takes 

 place after rupture of the cyst. 



If the seat of the eehinococcus is at the periphery of the lung, especially 

 if it has attacked an upper lobe, the symptoms resemble chronic pulmonary 

 tuberculosis; but the fair condition of nutrition, in spite of repeated hemop- 

 tysis, and the absence of the characteristic expectoration are opposed to this 

 view. Occasionally a complication with tuberculosis is present. Even when 

 the disease attacks a lower lobe, no signs are usually manifest other than 

 those of a pleural effusion. The nature of the affection is frequently deter- 

 mined only by exploratory puncture, which is performed with the expectation 

 of finding a pleural exudate or an empyema. 



The prognosis of pulmonary eehinococcus is serious, but by no means abso- 

 lutely unfavorable. In the Pomeranian statistics, among 16 cases spontane- 

 ous discharge of the cyst was followed by recovery in eight, and two were 

 cured by operative treatment. Death resulted from exhaustion in two cases. 

 One that was operated upon died. In another, pulmonary eehinococcus was 

 only an accidental autopsy finding. Surgical interference appears to be 

 advisable in all cases in which physical examination reveals suppuration and 

 putrefaction in the cyst. 



Eehinococcus of the mediastinum is uncommon. About six cases only are 

 on record. On account of the proximity to the heart and lungs, the eehino- 

 coccus here causes grave danger. 



Eehinococcus disease of the circulatory apparatus is rare. According to 

 Huber about 40 cases have been observed. To these may be added the eases 



