# A Diagnostic Masquerader in a Tuberculosis-Endemic Region: A Case of an Isolated Complicated Pulmonary Hydatid Cyst in an Adolescent

## TL;DR

A 15-year-old girl in a TB-endemic region was diagnosed with a rare pulmonary hydatid cyst, highlighting the importance of considering this condition in adolescents with chronic respiratory symptoms.

## Contribution

Presents a rare case of isolated pulmonary hydatid disease in an adolescent without typical zoonotic exposure in a TB-endemic region.

## Key findings

- Characteristic imaging findings (crescent and water-lily signs) aided in the diagnosis of a complicated pulmonary hydatid cyst.
- Successful treatment with albendazole and lung-preserving surgery led to full recovery without recurrence.
- Emphasizes the need to consider hydatid disease in adolescents with chronic respiratory symptoms in TB-endemic areas.

## Abstract

Pulmonary hydatid disease, caused by Echinococcus granulosus, remains an underrecognized etiology of chronic respiratory symptoms in endemic regions, particularly when classical exposure history is absent. We describe the case of a 15-year-old adolescent girl from rural India who presented with a one-year history of progressive cough and intermittent hemoptysis, refractory to empirical antibiotic therapy. Imaging revealed a well-defined cystic lesion in the left upper lobe, and contrast-enhanced computed tomography (CECT) demonstrated the coexistence of crescent and water-lily signs, indicating a complicated pulmonary hydatid cyst with impending rupture. Serological testing for Echinococcus granulosus IgG was positive, while extensive evaluation for tuberculosis and fungal infections was negative, and no hepatic or extrapulmonary cysts were identified. The patient was treated with preoperative albendazole followed by successful lung-preserving surgical enucleation, resulting in complete clinical and radiological recovery without recurrence. This case underscores the diagnostic value of characteristic imaging findings and highlights the necessity of considering pulmonary hydatid disease in adolescents with persistent respiratory symptoms in tuberculosis-endemic settings, even in the absence of identifiable zoonotic exposure.