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.