THE GREAT MIMICKER: A CASE OF RUPTURED LUNG CYST

Introduction: One of the most prevalent species,Echinococcus granulosus, is the parasite zoonotic infection that causes echinococcosis, also known as hydatid disease (HD). This species usually affects the liver, lungs, and, in rare cases, the kidney, muscles, bones, and spleen. Humans can only contract it through close contact with animals. Due to overlapping characteristics, pulmonary hydatid cysts might be mistakenly diagnosed as pneumonia in endemic areas like India,where tuberculosis (TB) is prevalent. A definitive diagnosis of HD can be established with the aid of radiological and pathological results.

Case Presentation: A 60-year-old male from Munsyari, Uttrakhand, presented with a 3 month history of breathlessness, cough, and expectoration. Despite being on anti-tubercular therapy (ATT) for two months which was advised by local practioner based on his clinical features, the chest X-ray opacities showed no improvement. Computed tomograp Hy (CT) revealed a 5.3 x 4.5 x 6.1 cm hypodense lesion in the right upper lobe with floating membranes and an "air bubble sign," suggesting a ruptured hydatid cyst. A second cyst was identified in the liver. However patient had no travel history in recent days but a thorough history revealed that patient was a pet dog owner which is a well known risk factor for E.granulosus and thus causing echinococcosis.The patient was treated with Albendazole and underwent a cystostomy with capitonnage via thoracotomy. The sample was later sent for gold standard histopathology and a final diagnosis of hydatid cyst was given.