A 3-year-old Ethiopian boy came to the hospital with four months history of progressive dry cough and progressive worsening of shortness of breath accompanied by low grade intermittent fever. There was no history of contact with a tuberculosis patient. He had no history of weight loss, yellowish discoloration of the skin or sclera, abdominal pain and abdominal distention. He passed most of his day time playing with the dog. The patient received different kinds of po antibiotics and salbutamol puffs considering pneumonia and hyper reactive airway disease since the age 2 years and 6 months with no relief. Physical examination during admission revealed an acutely sick-looking child with a breathing rate of 60 breaths per minute, a saturation of oxygen (80% with atmosphere oxygen) and a temperature of 37.4 degrees centigrade. Chest examination showed flaring of alae nasi, subcostal and intercostal retractions, diffuse bilateral wheeze and decreased air entry on lower lung fields bilaterally.
Investigations from referral showed the complete blood count, organ function test and abdominal ultrasound were non-revealing. During admission a posteroanterior chest X-ray was done, which showed bilateral lung mass with homogenous opacification of the right and left hemithorax (Figure 1).
Chest ultrasound showed well-defined cystic mass lesions at the site of the mass with no septations or debris and the impression being cystic lung mass lesions. For further clarification computed tomography of chest was done and showed large bilateral thick-walled cystic lesions sizes of 9 x 7.5 x 7.6 cms in the right side and 8.3 x 7.8 x 5.4 cms in the left side, both located in the lower segments of the upper lobe. Bilateral perihilar extension and pressure effect on the diaphragm with surrounding atelectatic changes and fissural thickening with minimal interfissural fluid were found in the left side (Figure 2).
With the consent from the parents, left posterolateral thoracotomy and hydatid cystic mass excision (cystectomy) were done. Intraoperatively there was a 8 x 7cms well-defined cystic mass arising from left upper lobe inter-lobe fissure attached to the left lower lobe surface. The whole cyst was removed with no spillage (Figures 3A and B). Two months later, right posterolateral thoracotomy and cystectomy were done for the right lung hydatid cyst. The whole cyst was removed with no spillage for the right hydatid cyst as well and the child recovered well post-operatively.