Hydatid cyst (ruptured with hydropneumothorax)

Case contributed by Abdallah Alqudah
Diagnosis almost certain


Adolescent male presented to the ER with sudden onset cough, and shortness of breath.

Patient Data

Age: 15 years
Gender: Male

Initial imaging


Posteroanterior chest X-ray at presentation showing an increase in the right lung lucency, with air-fluid level and shifting of the mediastinal structures to the left side representing tension hydropneumothorax.

Post chest tube


Post chest tube insertion, decrease in the degree of pneumothorax with mediastinum back to its normal position.

Intraparenchymal cyst with thick wall seen in the posterior segments of the right lower lung lobe is most likely representing hydatid cyst.

Another cavitary lesion noted in the anterior segment of the right upper lung lobe containing air and soft tissue component seen in the dependent part of the cavity, most likely representing ruptured hydatid cyst.

Areas of consolidation with air bronchogram seen involving most of the right lung lobe.

Moderate amount of pleural effusion and pneumothorax noted on the right side.
A chest tube is seen in situ with traumatic subcutaneous emphysema noted in the chest wall and the right aspect of the neck.

In the visualized portion of the upper abdominal organs, intrahepatic biliary dilatation is seen.

Case Discussion

The adolescent male presented with sudden onset severe SOB. Initial chest x-ray findings of hydropneumothorax and the serous fluid that came out upon chest tube insertion make ruptured simple pleural pleb less likely.

CT was the next step which revealed an intraparenchymal right lower lung lobe cyst highly suggestive of hydatid disease. The other irregular upper lobe cyst is mostly a ruptured cyst which caused the patient findings.

Fluid analysis has confirmed the diagnosis of hydatid disease.

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