The Impact of Fissure-Adjacent Localization on Rupture Risk in Pulmonary Hydatid Disease.

Background Pulmonary hydatid cyst (PHC) rupture is a serious complication that can increase surgical difficulty and postoperative morbidity. Identifying preoperative predictors of rupture is essential for patient risk stratification and optimal surgical timing. This study aimed to evaluate clinical, radiological, and laboratory factors associated with cyst rupture, with a particular focus on the anatomical relationship with lung fissures. Methods A retrospective analysis was conducted on 37 patients who underwent surgery for pulmonary hydatid cysts between January 2012 and December 2021. Patients were categorized into ruptured and intact cyst groups. Demographic, radiological, hematological, and operative data were compared. Logistic regression was used to identify independent predictors of rupture. Results Cyst rupture was observed in 19 patients (51.4%). Preoperative C-reactive protein (CRP) levels and the presence of fissure connection were significantly higher in the ruptured group (p < 0.05). Multivariate logistic regression revealed that fissure relationship was an independent predictor of rupture (odds ratio {OR}: 5.150; 95% confidence interval {CI}: 0.957-27.719; p = 0.049). Cyst size and location were not significant predictors in the adjusted model. The model showed acceptable fit (Hosmer-Lemeshow p = 0.094) and moderate predictive power (Nagelkerke R² = 0.447). Conclusion Fissure involvement is a key anatomical risk factor for pulmonary hydatid cyst rupture and should be carefully assessed during preoperative imaging. The early identification of fissure-associated cysts may guide surgical planning, reduce complications, and improve patient outcomes.