Management strategies in bilateral pulmonary hydatid cysts in children

Hydatid disease is a zoonotic parasitic infection, endemic in many livestock-rearing regions, and remains a significant health concern. We report our experience managing childhood bilateral pulmonary hydatid cysts and discuss management strategies.

This was a retrospective analysis of data from the cohort of hydatid patients treated over a period of 5 years from January 2020 to December 2024. The care records were reviewed and data on clinical and radiological presentations were studied. The anesthesia and surgical management and intraoperative events were also recorded. The perioperative complications and hospital stay were studied, along with postoperative pharmacotherapy and recurrence. These patients were followed up for a minimum of 12 months.

Out of 52 patients diagnosed with hydatid, 9 (aged 4-12 years, 66.7% male) were treated for bilateral hydatid lung. Cough was the commonest symptom, followed by fever and hemoptysis. The number of cysts ranged from one to three on either side. The cohort had low complication rates, with 88.9% avoiding major intraoperative spillage. Major intraoperative complications occurred in one patient, with one patient experiencing a mild postoperative air leak. Single-stage surgeries significantly reduced hospital stays (p = 0.049) and surgery duration per session (p = 0.013). Complication predictors, including liver involvement, cyst number, and diameter, were comparable. A follow-up between 12 and 60 months revealed recurrence in one patient on one side.

Surgery remains the definitive treatment for bilateral pulmonary hydatid cysts in children. Single-stage approaches are effective in reducing hospitalization times, while postoperative medical therapy ensures low recurrence rates. Conservative methods prioritizing parenchymal preservation should remain the cornerstone of surgical management.