Rupture of Echinococcus granulosus leading to severe hypoxia: preoperative and postoperative management.

A previously healthy 13-year-old boy was brought to the emergency department in critical condition following a fainting episode, showing signs of cyanosis, acute respiratory distress and a weak radial pulse. Epinephrine and oxygen supplementation were administered in the local Paediatric Emergency Service. A history of vomiting clear fluid and 'grape skin' was reported by the teacher.After clinical and chest X-rays were performed, a large air-fluid cavity was revealed in the upper and middle fields of the right lung. A contralateral infiltrate was also present as well. After a CT thorax scan, a diagnosis of cystic echinococcus was made after a CT thorax scan. Blood tests and serological tests for echinococcus were negative.The child received conservative treatment for several days, which included oxygen supplementation, antibiotics, aerosol therapy and kinesitherapy. This approach helped to open the primary bronchi and trachea, facilitating a reduction in the size of the cavity. Albendazole was administered 5 days prior to the surgical intervention.Surgical intervention consisted of endocystectomy and capitonnage, conserving the parenchyma. Spillage during the rupture, which caused bronchial obstruction from degrading scolexes of the contralateral side, was managed through flexible bronchoscopy.The patient experienced a favourable outcome with full clinical and radiological resolution after a 6-month course with albendazole and supportive therapy.