Diagnosis and management challenges of a pulmonary hydatid cyst in the context of the COVID-19 pandemic – case presentation

Hydatid cyst is a parasitic disease which occurs in multiple locations. The pulmonary localisation is preferential and responsible for an important symptomatology, being the second localisation after the hepatic one, which in most cases evolves asymptomatically. We present the case of a 24-year-old patient, who is a non-smoker and has had exposure to respiratory allergens (cat hair and dog hair), and who was admitted to the Pneumology Hospital with the complaints of cough with mucopurulent sputum and minimal haemoptysis and mild fever (37.1°C). It was reported that 3–5 weeks before hospitalisation, the patient had presented with an episode of vomiting, in moderate amounts with a typical appearance, but in the current context of the Coronavirus Disease-2019 (COVID-19) pandemic, he had delayed his presentation to the hospital. On clinical evaluation, the patient presented with diminished right basal vesicular murmur with overlying crackling rales. Following the investigations, the postero-anterior pulmonary radiography describes, at the level of the right lung, a hydro-aerial image with an uncertain appearance of unspecified aetiology. In this context, a native chest tomography (CT) was performed, which revealed a cystic formation at the level of the middle lobe, with thin walls and a prolific membrane detached inside, which are suggestive aspects for a hydatid cyst. Subsequently, a surgical consultation was performed, which concluded the superinfection of the cyst by a secondary lung abscess and the need for lobectomy. The peculiarity of the case consists in the appearance of persistent symptomatology and complications in a young patient without comorbidities and risk factors, and the fact that an accurate diagnosis was delayed because of the patient’s delayed presentation in the hospital in the context of the COVID-19 pandemic.