Fatal multi-organ failure following delayed diagnosis of ruptured pulmonary hydatid cyst in an 11-year-Old boy: The airway management dilemma ('intubate or not intubate').

Hydatid disease (cystic echinococcosis), caused by Echinococcus granulosus, is a zoonotic infection that can involve the lungs, particularly in endemic regions. We report an 11-year-old boy with a 4-month history of chronic cough following an upper respiratory infection. He presented acutely with recurrent vomiting, hemoptysis, severe respiratory distress, and hypoxemia (SpO2 82% on oxygen). Blood pressure was preserved and there were no clinical features of anaphylaxis or sepsis at arrival. Imaging confirmed a ruptured left pulmonary hydatid cyst with bronchial fistula; right-sided radiographic opacities were also present and likely reflected aspiration of cyst contents contributing to the initial severity. Emergency thoracotomy, cyst resection, and chest-tube drainage of an associated pneumothorax (reflecting bronchopleural fistula) were performed Imaging revealed a ruptured pulmonary hydatid cyst. He underwent emergency left thoracotomy with cyst resection and chest tube placement. Postoperatively, he developed acute kidney injury with oliguria, managed conservatively, along with ongoing respiratory complications. Albendazole therapy was initiated. This case highlights the diagnostic delays, airway management challenges, and high morbidity of complicated pulmonary hydatid disease in children.