When size matters: Managing a giant pulmonary hydatid cyst in a pediatric patient: Case report.

RATIONALE: Giant pulmonary hydatid cysts in children are rare, with nonspecific symptoms often delaying diagnosis. Preservation of lung parenchyma during surgery is essential. This is the first reported case of such a cyst in a Palestinian pediatric patient.

PATIENT CONCERNS: A 5-year-old girl presented with progressive left flank pain, dyspnea, and fever; initially misdiagnosed as gastroenteritis.

DIAGNOSES: Chest X-ray and computed tomography revealed a hydatid cyst occupying >90% of the left lower lung lobe with pleural effusion.

INTERVENTIONS: Urgent lateral thoracotomy combined with video-assisted thoracoscopic surgery was performed for cyst evacuation and sterilization, preserving lung parenchyma.

OUTCOMES: Successful removal with uneventful recovery; discharged in stable condition after 6 days.

LESSONS: Early imaging and diagnosis are critical. Hybrid surgical approaches can remove large cysts while preserving lung tissue. Hydatid disease should be considered in children with unexplained respiratory or gastrointestinal symptoms in endemic regions.