Complicated pulmonary hydatid cysts presenting with pleural extension and tension pneumothorax: a retrospective case series

Background: Pulmonary hydatid disease remains endemic in many Mediterranean and Middle Eastern regions. Complicated cysts with pleural extension or rupture may present with acute respiratory compromise and require urgent surgical management. Methods: A retrospective case series was conducted at Al-Mouwasat University Hospital over a 5-month period. Three consecutive patients diagnosed with complicated pulmonary hydatid cysts were identified from institutional medical records. Clinical, laboratory, radiological, operative, and outcome data were analyzed. This study is reported in accordance with the PROCESS 2020 guidelines for surgical case series. Results: The mean age was 23 years (range 16–28); two patients were female. All cases involved the right lung (100%). One patient (33%) presented with tension pneumothorax and mediastinal shift. All patients required emergency chest tube placement, and definitive management consisted of right thoracotomy with cyst excision and pleural decortication. Bronchopleural or pleural fistulas were identified intraoperatively in all cases. There was no mortality. All patients achieved full lung re-expansion and were discharged in stable condition. Conclusion: Complicated pulmonary hydatid cysts may present with acute pleuropulmonary manifestations, including tension pneumothorax. Early recognition and timely surgical intervention are essential for definitive management and favorable outcomes.