Hydatid Pulmonary Embolism: A 25-Year Single-Center Case Series with Review of Current Management

Introduction Hydatid pulmonary embolism is a rare but serious complication of cystic echinococcosis. It most often results from the rupture of a cardiac hydatid cyst into the right chambers or, more rarely, from the extension of a hepatic cyst into the inferior vena cava with embolic migration to the pulmonary arteries. Diagnosis is difficult due to non-specific clinical presentation. Methods We conducted a retrospective study including patients treated for hydatid pulmonary embolism in the thoracic and cardiovascular surgery department between 2000 and 2024. Clinical, radiological, therapeutic and evolutionary data were analysed. Results Nine patients were identified (5 women, 4 men), with a mean age of 39 years (19–64 years). All were symptomatic. The diagnosis was based on chest computed tomography and/or pulmonary angiography. The involvement was right-sided in six cases, left-sided in one case and bilateral in two cases. Six patients had an associated hepatic cyst and two had cardiac involvement. Eight patients underwent surgery (lobectomy, segmentectomy, pneumonectomy or embolectomy with cystectomy). One patient died before surgery due to compressive pericardial effusion. The average length of postoperative hospitalisation was four days, with no immediate complications. At follow-up (6 months to 7 years), the majority of patients were stable. One late death due to acute heart failure occurred at 12 months and one recurrence was observed at 7 years. Conclusion Hydatid pulmonary embolism is a rare condition with a potentially severe prognosis. Surgical treatment remains central. The role of adjuvant medical treatment with albendazole remains to be clarified.