| Clinical features and surgical outcomes of cerebral
hydatid disease were recently discussed by Hasan et
al.1 In their case series, they introduced bypassing the
liver as the route of pulmonary involvement.1 However,
2 other distinct pathways have also been introduced
for pulmonary hydatidosis; lymphatic spread via the
thoracic duct into the right heart and ultimately to
the pulmonary parenchyma, and direct pulmonary
exposure from inhalation of eggs. Indeed, the former
is considered a major pathway for the larvae to bypass
the hepatic sinusoidal system, raising the probability
of cerebral involvement.2,3 The diagnosis of hydatid
disease is based on several modalities among which
non-invasive imaging and serological tests are of high
value.4 Serodiagnostic tests are frequently used for the
preoperative diagnosis of extrahepatic hydatid disease,
despite not being as sensitive as for liver hydatosis.5
Nonetheless, eosinophilia in the peripheral blood is
usually informative.6 This diagnostic criterion seems to
have been overlooked by Hasan et al. |