Video-Assisted Thoracoscopic Management of a Ruptured Pulmonary Hydatid Cyst

Pulmonary hydatid cysts may be managed surgically and/or with pharmacotherapy. Surgery is indicated in cases where the cyst is superficial, infected, exerting substantial mass effect, located in a vital anatomical location, or there is high risk of rupture (1). Video-assisted thoracoscopic surgery (VATS) is an effective and safe option for managing an intact or ruptured solitary pulmonary hydatid cyst (2, 3). Minimally invasive intervention offers the advantages of reduced perioperative pain and trauma resulting in shorter hospital stay, fewer postoperative complications, and faster recovery (3). To the authors’ knowledge, this is the first report of VATS management of a ruptured pulmonary hydatid cyst.

The patient was an otherwise healthy 26-year-old woman who presented with shortness of breath and chest pain. The patient was advised to quarantine based on suspicion of COVID-19. A week later, the patient presented to the emergency department with a pleural effusion and hemoptysis. She had an ultrasound of the pleural space and then a small-bore chest tube was inserted. The patient had CT and was diagnosed with a ruptured pulmonary hydatid cyst. The patient subsequently had two chest tubes inserted and three doses of intrapleural fibrinolytic therapy. She was then taken to the operating room for surgical management. Postoperatively, the patient had three chest tubes. The chest tubes were removed sequentially and she was discharged home on postoperative day 12. The patient had no intra-operative or postoperative complications.

References

1. McManus DP, Zhang W, Li J, Bartley PB. Echinococcosis. Lancet. 2003;362(9392):1295-1304.
2. Abbas N, Zaher Addeen S, Abbas F, Al Saadi T, Hanafi I, Alkhatib M, et al. Video-assisted Thoracoscopic Surgery (VATS) with mini-thoracotomy for the management of pulmonary hydatid cysts. J Cardiothorac Surg. 2018;13(1):35.
3. Turna A. Minimally invasive approach for pulmonary hydatid cyst. J Vis Surg. 2019;5:16-16.

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