Abstract Introduction Hydatid disease is a zoonosis caused by Echinococcus spp., most commonly affecting the liver followed by the lungs. Cyst rupture may present with chest pain, dyspnea, cough or anaphylaxis. Rupture into a bronchus produces hydatid vomica; less commonly, drain into the pleural space causes pneumothorax or hydropneumothorax Case Report A 62-year-old man from Otuzco, Trujillo, Peru, initially presented with hemoptysis. CT chest and abdomen demonstrated a 10 x 15cm cystic lesion at the left lung base and a 20 x 10 cm hepatic cyst in the right lobe. Western Blot was positive, confirming pulmonary and hepatic hydatic cyst. He was discharged on 04 week course of albendazole. 07 weeks after initial presentation, he returned with acute dyspnea, pleuritic pain and cough. CBC showed eosinophilia. Chest x-ray showed left hydropneumothorax with air-fluid level with irregularities. Thoracostomy drainage was done. Cultures were negative. Repeat CT chest showed a ruptured cyst in the left lower lobe with air-fluid interface. He underwent a lower left lobectomy which confirmed ruptures hydatid cyst towards the diaphragmatic surface with protruding membranes. Discussion Echinococcosis incidence exceeds 50/100,000 people annually worldwide, particularly in rural areas and endemic zones in South America. Rupture of pulmonary hydatid cysts into the pleural cavity is an uncommon complication, occurring in only 0.6-16% of reported cases (3), and hydropneumothorax in 2-4% of cases. Albendazole is first-line therapy due to its high bioavailability and intracystic absorption, promoting degeneration and resolution. However, during or after therapy, progressive weakening of the cyst wall can lead to rupture. Studies indicate that between the third and fourteenth day of albendazole treatment, the germinal layer may become partially damaged, increasing rupture risk. Due to the above, we consider that our case is particularly interesting, since the presence of a hydropneumothorax is an uncommon entity, and its extension into the pleural cavity constitutes an even rarer presentation. This abstract is funded by: None
Chambi et al. (Fri,) studied this question.