Background: Hydatid disease is a parasitic infection characterized by cystic lesions in the liver, lungs and rarely in other body parts.Case Report: We report a 15-year-old South Eastern European emigrant, admitted with high fever, productive cough with purulent sputum, shortness of breath and cardio-respiratory distress. A CT scan of the chest showed a complicated giant pulmonary round cyst collapsing the upper and middle lobe of the right lung, with an irregular air fluid level (indicating cystobronchial communication), small daughter cysts and mediastinal shift to the left. There was a dramatic relief of hyponsion and tachycardia following insertion of a CT guided percutaneous pleural catheter; subsequently the patient underwent thoracotomy in a stableand controlled condition.Conclusions: Cystobronchial communication in large echinococcus cysts of the lung can mimic cardiac tamponade or tension pneumothorax causing cardiorespiratory distress. CT guided percutaneous drainage of such a cyst is a safe and effective method as initial emergency treatment and after stabilization of the patients’ condition a formal surgical procedure can be carried out.

Keywords: Hydatid disease, lung cysts