Intraoperative Ventilatory Collapse from Negative Pleural Suction in a Ruptured Pulmonary Hydatid Cyst.

A 52-year-old male with a ruptured right hydatid cyst underwent thoracotomy and cyst excision. After repair of diffuse parenchymal air leaks, application of negative pleural suction caused sudden ventilatory collapse with refractory hypotension, unresponsive to tube exchange or vasopressors. Lung-protective ventilation failed until clamping the drain immediately restored tidal volumes, confirming suction-mediated negative-pressure failure. Ultrasound showed good re-expansion without pneumothorax; subsequent pink frothy secretions suggested re-expansion/negative-pressure pulmonary oedema. Switching to a water-seal drain, optimizing ventilation, and diuretics led to rapid recovery. Negative pleural suction can be hazardous after parenchymal leak repair.