Unveiling the Unexpected: Isolated Pulmonary Echinococcosis in a Non-Endemic Setting

Document Type

Conference Proceeding

Publication Date

5-15-2026

Publication Title

Am J Respir Crit Care Med

Keywords

General & Internal Medicine, Respiratory System

Abstract

Background Echinococcosis, caused by Echinococcus granulosus, is a parasitic infection that forms cysts primarily in the liver (60-70%) and lungs (20-30%). These cysts may enlarge, compress adjacent tissue, or rupture, leading to allergic or infectious complications. Isolated pulmonary involvement without hepatic disease is rare (8-10%) and often mimics congenital or neoplastic cysts radiologically. Here, we report an unusual case of isolated pulmonary echinococcosis. Case A 19-year-old female, born in Yemen and residing in the United States, presented with a six-month history of progressive dyspnea, cough, and left-sided chest pain. Her symptoms were initially attributed to asthma. Chest radiograph revealed near-complete opacification of the left lower lung, and CT showed a large (14.1 × 10.5 × 17.8 cm) cystic lesion in the left lower lobe, initially interpreted as a congenital bronchogenic cyst. She underwent robotic-assisted left lower lobectomy with lymph-node sampling and nerve cryoablation. Approximately 1 L of clear cyst fluid was aspirated intraoperatively. Pathology confirmed an Echinococcus cyst, negative for malignancy, with all lymph nodes free of organisms or neoplasia. Postoperatively, she recovered well, with complete symptom resolution and no recurrence at follow-up. Discussion: Pulmonary echinococcosis is an infrequent diagnosis in developed nations, where parasitic lung infections are rarely encountered. This case is remarkable for several reasons. The patient’s young age and isolated pulmonary involvement without hepatic disease represent an atypical manifestation, seen in fewer than 10% of cases.The markedly large cyst and its indolent six-month course contributed to diagnostic ambiguity. Her respiratory symptoms were initially attributed to asthma, while imaging suggested a congenital bronchogenic cyst or mediastinal mass—illustrating the variable imaging features of hydatid disease and its ability to mimic benign or neoplastic pathology.The successful application of robotic-assisted lobectomy underscores the evolving role of minimally invasive surgery in parasitic pulmonary disease. Compared with conventional thoracotomy, the robotic platform affords enhanced visualization, refined dissection, and faster recovery. Reports of such an approach in North America remain exceedingly rare.Finally, this case highlights the importance of diagnostic vigilance when evaluating cystic lung lesions in patients with possible epidemiologic exposure. Because imaging findings are often nonspecific, histopathologic confirmation remains essential for definitive diagnosis and management. Conclusion: Isolated pulmonary echinococcosis can present subtly in non-endemic settings, often mimicking congenital or neoplastic lung disease. Awareness of this rare entity is crucial for timely recognition. Robotic-assisted lobectomy provides a safe, definitive treatment with excellent recovery outcomes.

Volume

212

First Page

1

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