A 28-year-old male, cook by occupation, presented to the outpatient department with complaints of right-sided neck swelling for eight months, along with fever, dry cough, and left-sided chest pain for ten days. The neck swelling was initially small but had gradually increased in size and was painless. The patient also complained of ill-defined chest pain over the left anterior chest without any radiation, aggravating or relieving factors. Past medical history was unremarkable. On examination, his vitals were stable. A 2 x 2 cm sized cystic, non-tender mobile swelling was noted in the right cervical region. There were no signs of inflammation on skin overlying the swelling. Respiratory system examination revealed dull notes on percussion involving left mammary, axillary, and infraaxillary areas with reduced intensity of breath sound in the same regions compared to the right side. The patient was admitted for further evaluation. Chest x-ray PA view was suggestive of a well-defined encysted lesion involving the left mid zone, extending to the left lower zone (Fig. 1A). USG neck was representative of a well-defined cystic lesion 2.2 x 2.5 cm size in the right cervical region in the subcutaneous plane. Ultrasound of the abdomen was unremarkable. His routine blood investigations did not show any abnormality or eosinophilia.
CT Chest (Fig. 1B-D) showed the presence of a hypodense lesion with internal fluid attenuation measured approximately 12 x 9 cm in size in the left upper lobe with adjacent cavitation and ground glass haziness, suggestive of ruptured cyst with secondary infection. Fine-needle aspiration was done from his right cervical swelling. Smears demonstrated the presence of eosinophilic material with a laminated layer at the periphery which also pointed towards the probability of hydatid disease. Following this, an excisional biopsy was performed from the cervical swelling, which showed a laminated cyst wall, and the diagnosis of hydatic cyst of the neck was confirmed. Contrast-enhanced MRI chest showed the presence of a fluid-filled thick-walled cystic lesion in the left upper lobe. Another small air-filled cavity was present inferolateral to the cyst. With the provisional diagnosis of hydatid disease of the left lung, echinococcus serology was done, and it was positive for IgG antibody ( 14.4 NovaTec-Units, NTU).
Meanwhile, the patient was initiated on oral albendazole 400 mg twice daily. Subsequently, the patient underwent enucleation of the left lung hydatid cyst. His postoperative course was uneventful. Patient was subsequently discharged ten days after the surgery. Albendazole was continued for a total of 8 weeks.