Is It Time to Abandon the Absolute Contraindication to FNAC in Pulmonary Hydatid Cysts? A Case Report and Literature...

Pulmonary hydatid cysts commonly mimic other pathologies on imaging, creating diagnostic challenges. Fine-needle aspiration cytology (FNAC) has historically been avoided because of concerns about anaphylactic reactions, despite evidence suggesting acceptable safety profiles. A 42-year-old female presented with a 2-year history of intermittent respiratory symptoms. Chest CT revealed an irregular pulmonary opacity in the right lower lobe with central fluid attenuation raising suspicion for lung abscess or malignancy. Laboratory investigations showed elevated inflammatory markers. CT-guided FNAC was performed without complications. It showed cytological features of a pulmonary hydatid cyst. The patient underwent successful posterolateral thoracotomy with wedge resection, and histopathological examination confirmed the diagnosis. Review of published literature shows that FNAC in hydatid disease, if performed with appropriate precautions, has minimal risk. The incidence of lethal anaphylaxis is extremely low (0.03%), with reversible allergic reactions in 1.7% of procedures. Multiple case series report successful diagnostic outcomes when FNAC is performed by experienced operators under image guidance and availability of anesthesiological support. This technique should not be considered absolutely contraindicated but a valuable tool when used cautiously.