An 8-year-old boy was admitted to the hospital with a 3-month cough. Imaging revealed a large cyst in his left lower lung lobe. He underwent surgery to remove an intact hydatid cyst from his left lower pulmonary lobe. The cyst was removed safely using aspiration and evacuation techniques to prevent spillage of cyst contents and a smooth postoperative recovery. Ensuring the safe removal of hydatid cysts from the lungs is important to avoid recurrence and complications from spilled cyst fluid.

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Intact Hydatid Cyst of the
Left Lower Pulmonary Lobe
Prof. Abdulsalam Y Taha
College of Medicine
University of Sulaimani
2022 1

2. The Case
 An 8-years old boy was admitted to
Sulaymaniyah Teaching Hospital,
Sulaymaniyah, Region of Kurdistan,
Iraq on the 21st of March 2004
because of dry cough of 3 months
duration. Physical exam revealed a
boy in a good general health apart
from reduced air entry on left
lower chest.
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4. CXR (PA and Lateral) views revealed a big
rounded smooth-outlined homogenous
opacity in LLZ
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6. CT scan of the chest (requested by the
referring doctor) showed a cystic lesion in
the LLL
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Courtesy of Prof. Abdulsalam Y Taha

9. The Case…
The child underwent a left
posterolateral thoracotomy,
during which a big intact
hydatid cyst of the left lower
pulmonary lobe was removed by
aspiration and evacuation
technique with a smooth
postoperative recovery.
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15. To summarize the case:
The diagnosis of intact PHC in an endemic
area is not difficult. Plain radiographic
appearance of (full moon against the dark
sky) is characteristic. The main concern is
the surgical removal of the cyst and its
contents safely, without spilling the
scolices-rich fluid into the surgical field and
thus avoiding recurrence and surgical
closure of the bronchial fistulae to achieve
early and full lung expansion
postoperatively. Safe removal requires
protection of the airways from fluid spillage
and drowning during surgery. This is the
combined responsibility of the surgeon and
anaesthesiologist. No double-lumen
endotracheal tubes are designed for
children due to their small airways.
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Careful entry into the pleural space,
avoidance of sudden rupture of the
cyst, walling off the cyst with packs
soaked in scolicidal agent, controlled
evacuation of the cyst contents,
keeping one or two good suckers
ready to use and the frequent
aspiration of the secretions from the
airways by the anaesthesiologist are
all necessary measures. Needless to
say, very good chest physiotherapy
is essential to get the goal of lung
expansion. A plug of viscid sputum
blocking a bronchus can spoil the
most meticulous pulmonary
operation.