WOFAPS 2025 8th World Congress of Pediatric Surgery

Hela Oueslati, Yasmine Houas, Fatma Thamri, Senda Houidi, Yosra Kerkeni, Sondes Sahli, Riadh Jouini, Said Jlidi

Department of Pediatric Surgery, Children’s Hospital, Faculty of medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

Introduction:

Pulmonary hydatid disease continues to pose a significant health concern in endemic regions, especially among pediatric populations. When a cyst ruptures into the pleural space, the clinical presentation can mimic other thoracic emergencies, often delaying accurate diagnosis and appropriate management. We report a rare and instructive case of a ruptured hydatid cyst into the pleural cavity in a child, initially misdiagnosed as a complicated pneumothorax.

Case:

An 8-year-old girl with no prior medical history, was referred to our Pediatric Surgery Unit at the Children’s Hospital in Tunis, Tunisia for further management of a right-sided total and compressive pneumothorax initially drained in a regional hospital.

Despite the severity of the radiologic findings, she remained clinically stable in ambient air. Laboratory results showed marked inflammation (WBC: 17,000/mm³;CRP:199 mg/L). A chest CT scan performed on day 7 revealed a large air-fluid cavity(80×50×77 mm) in the right lower lung lobe, communicating with the pleural cavity through a posterior defect, associated with pleural effusion and right lower lobe collapse. Abdominal imaging excluded hepatic or intra-abdominal hydatid disease.

Initial differential diagnoses included ruptured hydatid cyst, congenital pulmonary malformation, or post-infectious pneumatocèle. The patient was discharged under antibiotics, with close outpatient monitoring. A follow-up CT showed a stable cavity with persistent pleuro-parenchymal communication and serpiginous structures.

Surgical exploration confirmed a ruptured and superinfected hydatid cyst of the right lower lobe. A cystectomy with capitonnage and pleural drainage was performed. Postoperative recovery was uneventful. The patient was discharged on albendazole and antibiotics. At 2-year follow-up, the patient remained asymptomatic with no recurrence.

Conclusion:

Pulmonary hydatid cyst rupture into the pleural cavity may initially mimic other pathologies, complicating early diagnosis. High clinical suspicion and appropriate imaging are critical. Early surgical intervention, combined with antiparasitic treatment, ensures favorable long-term outcomes.