Concurrent Pulmonary and Hepatic Hydatid Disease: A Case Report and Literature Review

Concurrent Pulmonary and Hepatic Hydatid Disease: A Case Report and Literature Review

 

Khalil Saab, MD *, Nour Bazzal, MD 1, Riad Zbibo, MD 1, Ahmad Dabbagh, MD 2, Ibtisam Al Jamal, MD 1, Mohammad Dghaily 3

  1. Department of General Surgery, Makassed General Hospital, Beirut, Lebanon.
  2. Department of Cardiothoracic Surgery, Makassed General Hospital, Beirut, Lebanon.
  3. Medical Student Beirut Arab University, Beirut, Lebanon.

 

*Correspondence to: Khalil Saab, MD, Department of Surgery, Division of General Surgery, Makassed General Hospital, Beirut, Lebanon.

 

Copyright.

© 2026 Khalil Saab, MD, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 28 September 2026

Published: 13 October 2026

DOI: https://doi.org/10.5281/zenodo.23336933

 

Abstract

Hydatid disease caused by Echinococcus granulosus commonly affects the liver and lungs, but simultaneous involvement of both organs may present diagnostic and therapeutic challenges. We report a 34-year-old man with epigastric pain whose imaging revealed multiple hepatic hydatid cysts and a large right pulmonary cyst. He was treated with albendazole and staged surgical intervention, consisting of thoracotomy with excision of the pulmonary cyst followed by hepatic cyst unroofing and evacuation. Careful intraoperative precautions were taken to prevent cyst spillage, and histopathology confirmed hydatid disease. The postoperative course was favorable. This case emphasizes the importance of comprehensive imaging when hydatid disease is identified in one organ and highlights the role of individualized, multidisciplinary management in patients with simultaneous pulmonary and hepatic involvement.

Keywords: Hydatid disease; Echinococcus granulosus; Pulmonary hydatid cyst; Hepatic hydatid cyst; Echinococcosis.

Concurrent Pulmonary and Hepatic Hydatid Disease: A Case Report and Literature Review

 Introduction

Hydatid disease is a zoonotic parasitic infection caused by Echinococcus granulosus, with humans serving as accidental intermediate hosts after ingestion of parasite eggs. The liver is the most affected organ, followed by the lungs, although any organ may be involved. Simultaneous hepatic and pulmonary hydatid disease is uncommon and presents diagnostic and therapeutic challenges because of the risk of cyst rupture, dissemination, and the need for coordinated multidisciplinary management. We report a rare case of concurrent hepatic and pulmonary hydatid disease successfully treated with staged surgical intervention and adjunctive albendazole therapy.

 

Case Presentation

A 34-year-old previously healthy man presented with a one-day history of colicky epigastric pain. He denied nausea, vomiting, fever, bowel habit changes, or respiratory symptoms. Physical examination revealed epigastric tenderness with a positive Murphy’s sign, hepatomegaly, and splenomegaly. Laboratory evaluation showed leukocytosis (16.5 × 10?/L) with neutrophilia, while liver function tests, serum lipase, and urinalysis were within normal limits.

Abdominal ultrasonography demonstrated hepatomegaly with multiple hepatic cysts, the largest measuring 8.4 cm. Contrast-enhanced computed tomography (CT) confirmed multiple hepatic cysts with daughter cysts, the largest measuring 9.3 × 9.1 cm in segments V/VIII, exerting mass effect on adjacent structures (Figure 1). CT also identified a well-defined right lower lobe pulmonary cyst measuring 6.1 × 4.7 cm with adjacent consolidation, consistent with pulmonary hydatid disease (Figure 2).

Albendazole (400 mg twice daily) was initiated after diagnosis. Repeat chest CT showed enlargement of the pulmonary cyst to 9.3 × 5.5 × 5.3 cm with internal septations, confirming the need for surgical intervention. The patient first underwent right posterolateral thoracotomy through the fifth intercostal space with complete excision of the pulmonary hydatid cyst. Controlled aspiration and meticulous operative precautions were employed to prevent intraoperative spillage. The residual cavity was irrigated with a scolicidal solution, and a chest tube was inserted (Figure 3). Recovery was uneventful, and albendazole therapy was continued.

Three months later, hepatic surgery was performed through a right subcostal (Kocher) incision. The dominant cyst in segment VIII was unroofed and evacuated, while additional cysts in both hepatic lobes were similarly managed. The cavities were irrigated with cetrimide, and a drain was placed (Figure 4). Histopathological examination demonstrated laminated chitinous membranes with a fibrinoinflammatory pericyst, confirming hydatid disease (Figures 5 and 6).

The postoperative course was complicated by transient fever despite negative blood and urine cultures, which resolved with empiric antimicrobial therapy. The patient was discharged in good condition on albendazole with scheduled outpatient follow-up.

 

Discussion

Hydatid disease is a zoonotic infection caused by Echinococcus granulosus and remains endemic in many regions, particularly the Mediterranean basin, the Middle East, Africa, and South America, where sheep and cattle farming sustain the parasite life cycle (4). The liver is the most commonly affected organ, followed by the lungs. Simultaneous hepatic and pulmonary involvement is uncommon, occurring in approximately 10% of patients (2,3). This pattern of hydatidosis was first described by Tomalino in 1961. Peleg et al. reported that approximately 10% of patients with right-sided pulmonary hydatid cysts underwent simultaneous hepatic cyst removal, while Burgos et al. described transdiaphragmatic hepatic cyst excision in 7 of 331 patients with pulmonary hydatid disease (4).

Clinical manifestations depend on cyst size, location, and complications. Pulmonary hydatid disease commonly presents with cough, chest pain, hemoptysis, or dyspnea (5), whereas hepatic cysts usually manifest with right upper quadrant pain, hepatomegaly, weight loss, or fatigue. In our patient, the pulmonary cyst was an incidental finding on chest CT, as he had no respiratory symptoms, whereas the hepatic cysts were responsible for the presenting abdominal pain and hepatomegaly. This highlights the importance of comprehensive imaging once hydatid disease is identified in a single organ.

Surgery remains the cornerstone of treatment for symptomatic or large hydatid cysts. The principal objective is complete removal of the parasite while preventing intraoperative spillage and secondary echinococcosis. Enucleation of pulmonary hydatid cysts was originally described by Ugon in 1947 and later modified by Barrett and Thomas, who advocated obliteration of the residual cavity after cyst removal (6). In the present case, controlled aspiration, careful cyst excision, and irrigation with a scolicidal agent were performed to minimize contamination. Hepatic cysts were managed by unroofing, evacuation, cavity sterilization with cetrimide, and drainage.

The optimal sequence of surgery for concurrent pulmonary and hepatic hydatid disease remains controversial. We elected to treat the pulmonary cyst first because pulmonary cysts are more fragile and prone to rupture, while hepatic surgery may weaken the diaphragm and complicate subsequent thoracic intervention. This staged approach resulted in successful treatment without major complications.

Albendazole is recommended as an adjunct to surgery to reduce parasite viability and recurrence (7). However, chemotherapy alone is generally inadequate for large cysts because retained parasitic membranes may lead to persistent infection or secondary bacterial superinfection, and pulmonary cysts may rupture during treatment

(8). Accordingly, our patient received perioperative albendazole in combination with staged surgical management, resulting in complete recovery.

 

Conclusion

Concurrent pulmonary and hepatic hydatid disease is an uncommon manifestation of echinococcosis that requires a high index of suspicion and comprehensive imaging to identify multi-organ involvement. When hydatid disease is diagnosed in one organ, clinicians should evaluate for additional sites of involvement. Management should be individualized according to cyst location, size, and risk of rupture. A staged surgical approach combined with perioperative albendazole therapy can achieve excellent clinical outcomes while minimizing the risk of recurrence and disease dissemination.

 

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