Rupture of massive pulmonary hydatid cyst with tension hydropneumothorax

Case contributed by Dr Michael P Hartung



Patient Data

Age: 40 years
Gender: Male

Very large cyst filling the RLL resulting in compression of adjacent lung parenchyma. Small effusion. 

Rupture of RLL cyst with layering/floating membrane and air/fluid level, pleural thickening and debris, large hydronpneumothorax, collapse of the entire right lung with some peripheral air with irregular appearance involving the right upper lobe at the apex, and leftward mediastinal shift deviation. 

Case Discussion

Characteristic findings of pulmonary hydatid cyst before and after rupture in an endemic setting. Notice the floating membrane which is collapsed and quite striking within the pericyst cavity after the cyst eroded into the airway and ruptured. The floating membrane is also called the water-lily sign and is due to detachment of the endocyst from the pericyst. 

While rupture into an airway decompresses the cyst, unfortunately in this case rupture has also resulted in air entering the pleural cavity, and this patient now has a large tension hydropneumothorax with leftward mediastinal shift. This is an indication for urgent chest tube/needle decompression. 

Case courtesy Dr. Cathy Kim, MD

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