A Rare Complication of Hepatic Hydatid Cyst: Isolated Hepato-Pleural Fistula Mimicking Empyema

Introduction:Hydatid disease, caused by Echinococcus species, is a zoonotic infection that primarily affects the liver. Although most hepatic hydatid cysts remain asymptomatic, complications may arise as the cyst enlarges. Hepato-pleural fistula is an exceptionally rare complication, often difficult to diagnose due to its atypical presentation.Case Report:We present the case of a 59-year-old male with a known hepatic hydatid cyst who was admitted to the emergency department with acute dyspnea, fever, and purulent sputum. Imaging revealed a collapsed right lung and massive pleural effusion. Tube thoracostomy drained 1,300 cc of purulent fluid. MRI and fluoroscopy confirmed a hepato-pleural fistula originating from a ruptured hepatic hydatid cyst. The patient underwent percutaneous drainage followed by thoracotomy with diaphragmatic repair. He was discharged after combined surgical, interventional, and medical treatment including albendazole.Conclusion:Hepato-pleural fistula secondary to hepatic hydatid cyst is an extremely rare but serious complication. Emergency physicians should consider parasitic diseases in patients presenting with pleural effusion and acute dyspnea to ensure timely diagnosis and management.References:- Akkaya Işık S, Seyman D, Zerdali E, Ayan S, Kakaliçoğlu D, Ayaz T, et al. Evaluation of 170 Followed-up Cases Treated for Hydatid Disease: A Multicentre Study. Turk Parazitolojii Derg. 2020;44(4):197–202.- El Hammoumi M, Kabiri EH. Bilio-bronchial and bilio-pleuro-bronchial fistulas of hydatic origin. Pol J Cardio-Thorac Surg. 2021;18(4):239–46.- Varela Vega M, Durán F, Geribaldi N, San Martín G, Ettlin A. Hepatobronchial Fistula: A Rare Complication of Liver Abscess. Cir Esp. 2017;95(7):410–1