Thoracoscopy in diagnosis of ruptured pulmonary hydatid cyst.

A 26-year-old man presented with dyspnoea and pneumothorax diagnosed by chest radiography. He had previously presented with a massive right hydropneumothorax on his chest x ray 6 months ago, which was followed by 2 weeks of intercostal tube drainage resulting in a partial improvement of his symptoms. He was referred for a thoracoscopy to investigate the possible causes of the non-resolving pneumothorax, during which a large ruptured, crumpled hydatid cyst in the right pleural space, without empyema, was found. With a limited right thoracotomy, the crumpled laminated membrane of the hydatid cyst was removed. After extraction of the remaining particle of the laminated membrane of the same hydatid cyst in the right lower lobe and suturing of the bronchial opening, the pericyst layer was capitonnaged. Apart from common causes of pneumothorax in endemic areas, ruptured pulmonary hydatid cyst should be considered in pneumothoraces with an unusual clinical course.