Ruptured Pulmonary Hydatid Cyst Presenting With Hemoptysis in a Term Pregnancy: A Case Report and Literature Review

Hydatidosis, or cystic echinococcosis, is an anthropozoonosis caused by the larval form of Echinococcus granulosus. A ruptured pulmonary hydatid cyst occurring during pregnancy is rare and confronts the clinician with a dual maternal and fetal imperative. We report the case of a 31-year-old patient from a rural background, gravida 3, in the third trimester of a term pregnancy, admitted for hemoptysis following lower thoracic pain and a dry cough that had been present for two weeks. On examination, the patient was hemodynamically and respiratorily stable. Chest CT angiography revealed a cavitary lesion of the left lower lobe communicating with the bronchi, consistent with a ruptured hydatid cyst, associated with alveolar hemorrhage and without pulmonary embolism. As the pregnancy was already at term, a primary cesarean section was performed to avoid the expulsive efforts of a vaginal delivery, which were liable to aggravate the hemoptysis through the rise in intrathoracic pressure, and to secure the subsequent thoracic surgery; it resulted in the birth of a healthy newborn. A left lower lobectomy was performed two weeks later, and the maternal postoperative course was uneventful. This case illustrates the effectiveness of a sequential strategy involving a cesarean section followed by delayed surgical management in the treatment of a ruptured pulmonary hydatid cyst in a woman at term, with a favorable prognosis for both mother and child, provided that a multidisciplinary approach is adopted.