Case Report: Atypical Localization of a Pulmonary Hydatid Cyst

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The liver and lungs are the primary sites of infection, and mediastinal localization is extremely rare. We report the case of a 34-year-old patient with no significant medical history, who presented with right basithoracic pain and exertional dyspnea. Chest radiography revealed mediastinal widening, and further imaging with chest CT and magnetic resonance imaging (MRI) identified a right anterosuperior multivesicular mediastinal hydatid cyst adjacent to the pericardium. The patient underwent surgery with favorable postoperative outcomes." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/14-285/v1", "name": "Case Report: Atypical Localization of a Pulmonary Hydatid Cyst" } } ] } Home Browse Case Report: Atypical Localization of a Pulmonary Hydatid Cyst ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Karaborni B, Kamoun H, Rejeb H et al. Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.12688/f1000research.162741.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] Bochra Karaborni https://orcid.org/0009-0000-7980-3145 1 , Hela Kamoun https://orcid.org/0000-0003-4431-846X 1 , Hadhemi Rejeb 1 , Imene Bouassida 2 , Hanene Smadhi https://orcid.org/0000-0002-6241-3842 1 , Leila Fekih 1 Bochra Karaborni https://orcid.org/0009-0000-7980-3145 1 , Hela Kamoun https://orcid.org/0000-0003-4431-846X 1 , [...] Hadhemi Rejeb 1 , Imene Bouassida 2 , Hanene Smadhi https://orcid.org/0000-0002-6241-3842 1 , Leila Fekih 1 PUBLISHED 12 Mar 2025 Author details Author details 1 Pneumology Department Ibn Nefiss, Hospital of Pneumo-Phtisiology Abderrahman Mami, Ariana, Ariana, Tunisia 2 Thoracic Surgery Department, Hospital of Pneumo-Phtisiology Abderrahman Mami, Ariana, Ariana, Tunisia Bochra Karaborni Roles: Conceptualization, Data Curation, Investigation, Methodology, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Hela Kamoun Roles: Formal Analysis, Methodology, Resources, Supervision, Validation, Visualization Hadhemi Rejeb Roles: Formal Analysis, Supervision, Validation, Visualization Imene Bouassida Roles: Data Curation, Supervision, Visualization Hanene Smadhi Roles: Data Curation, Formal Analysis, Resources, Supervision, Validation, Visualization Leila Fekih Roles: Supervision, Validation, Visualization OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Rare diseases collection. Abstract Hydatid disease is a significant public health concern in endemic regions. The liver and lungs are the primary sites of infection, and mediastinal localization is extremely rare. We report the case of a 34-year-old patient with no significant medical history, who presented with right basithoracic pain and exertional dyspnea. Chest radiography revealed mediastinal widening, and further imaging with chest CT and magnetic resonance imaging (MRI) identified a right anterosuperior multivesicular mediastinal hydatid cyst adjacent to the pericardium. The patient underwent surgery with favorable postoperative outcomes. READ ALL READ LESS Keywords Echinococcosis,Hydatid Cyst,Mediastinal Cyst,Pericardial effusion,Surgical Procedures, Operative Corresponding Author(s) Bochra Karaborni ( [email protected] ) Close Corresponding author: Bochra Karaborni Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Karaborni B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Karaborni B, Kamoun H, Rejeb H et al. Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.12688/f1000research.162741.1 ) First published: 12 Mar 2025, 14 :285 ( https://doi.org/10.12688/f1000research.162741.1 ) Latest published: 12 Mar 2025, 14 :285 ( https://doi.org/10.12688/f1000research.162741.1 ) Introduction Hydatid disease, or hydatid cyst (HC), is a metacestodiasis caused by the larval form of the small canine tapeworm Echinococcus granulosus. Hydatid cysts predominantly affect the liver and lungs, which filter, and prevent parasite dissemination into the systemic circulation. Mediastinal hydatid cysts are exceptionally rare, comprising 0%–4% of all cases. 1 These cysts often pose a diagnostic challenge as they can be confused with other mediastinal lesions. Case report A 34-year-old male smoker with a 16-pack-year history and no notable medical history presented to the emergency department with a week-long history of bilateral basithoracic pain radiating posteriorly, rated 7 out of 10, and exertional dyspnea (mMRC grade 1). On physical examination, the patient was afebrile and stable in terms of both hemodynamics and respiratory function. Laboratory tests revealed inflammatory syndrome with a CRP level of 240 mg/L. Thoracic CT angiogram revealed a right anterior mediastinal mass with multiple loculations associated with pericarditis. Abdominal imaging showed two hepatic hydatid cysts. Thoracic magnetic resonance imaging (MRI) confirmed a 54 × 48 × 60 mm multivesicular hydatid cyst in the right anterosuperior mediastinum, adjacent to the pericardium, with pericardial effusion and leaflet thickening ( Figure 1 ). Lateral tracheal and subcarinal lymphadenopathies were also observed. The hydatid serology test results were positive. The patient underwent surgery through a right lateral thoracotomy, where a cystic formation in the mediastinum was found in proximity to the pericardium and supra-aortic vessels, extending toward the lung. Cystectomy and lymph node dissection at stations 2R and 4R were performed. The patient’s postoperative course was uncomplicated. Histopathological analysis revealed a pulmonary hydatid cyst with reactive lymph nodes, and no signs of malignancy. Figure 1. Mediastinal hydatid cyst with pericardial effusion on MRI. Discussion Hydatid disease is a parasitic infection caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most common locations and act as filters to prevent the systemic dissemination of the parasite. Mediastinal localization is very rare, occurring in 0.1% of cases in western countries and up to 4% in endemic regions. 1 However, the mechanisms underlying this localization remain unclear. One theory suggests that the parasite crosses the hepatic and pulmonary filters, enters the systemic circulation, and lodges in the mediastinum. Another possibility is that they migrate via the lymphatic and chylous pathways. 2 – 4 Mediastinal hydatid cysts can occur in any part of the mediastinum, with a preference for the posterior mediastinum. 5 The clinical presentation is non-specific, with chest pain and signs of mediastinal compression (dyspnea, dysphonia, and dysphagia) being common symptoms. However, mediastinal hydatid cysts can be discovered incidentally or may present with complications, such as rupture of the heart or large vessels. 5 – 7 Radiological imaging is crucial for diagnosing and assessing the extent of disease. Chest radiography typically shows a rounded or oval opacity in the mediastinum with hydatid tone. Thoracic ultrasound is a useful tool for assessing cyst characteristics, including the liquid content and thin walls. Membranous or vesicular detachment is suggestive, but rarely seen. 2 – 4 Thoracic CT imaging demonstrates a well-circumscribed mass of liquid density that does not enhance with contrast. 2 – 4 , 8 In our patient, the mass appeared to be an anterior mediastinal mass with multiple loculations. MRI provides detailed topographical information, helping to define the lesion’s relationship with neighboring organs, and may also reveal daughter cysts inside the main cyst. 1 – 4 The treatment of choice is surgical excision of the cyst, which is associated with favorable outcomes in most reports. 1 , 3 In our patient, the postoperative course was uncomplicated, and histopathological findings confirmed the diagnosis of a pulmonary hydatid cyst with reactive lymph nodes without malignancy. Conclusion Although rare, mediastinal hydatid cysts should be considered in the differential diagnosis of mediastinal masses, particularly in endemic regions. Imaging is essential for the diagnosis and evaluation of disease extent. Surgical excision remains the treatment of choice, with good outcomes in most cases. Ethical approval Ethical approval were not required. Consent for publication Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. The patient was informed that all personal information would be removed to ensure confidentiality and anonymity. The patient acknowledged that the case details and images were freely available online and accessible to the public. Data and software availability No data are associated with this article. References 1. Souhi H, Zegmout A, Janah H, et al. : A rare cause of posterior mediastinal tumors: mediastinal hydatid cyst. Pan Afr. Med. J. 2016 [cited 2025 Mar 1]; 25 : 122. Publisher Full Text Reference Source 2. Skalli AEA, Amraoui FE, Chikhaoui N: Hydatid cyst of the mediastinum: about 2 cases. J. Radiol. 2025; 81 : 154–157. 3. Akkari K, Chnitir S, Miled M, et al. : Cervico-mediastinal hydatid cyst: a case report. J. Tunis ORL Chir Cervico-Faciale. 2010 Aug 12 [cited 2025 Mar 1]; 19 (1). Publisher Full Text Reference Source 4. Zidi A, Zannad-Hantous S, Mestiri I, et al. : Primary hydatid cyst of the mediastinum: 14 cases. J. Radiol. 2006 Dec; 87 (12): 1869–1874. PubMed Abstract | Publisher Full Text 5. Aloui-Kasbi N, Chennoufi F, Boussetta K, et al. : Mediastinal hydatid cyst: a new observation. J. Pediatr. Puériculture. 2004 Sep; 17 (6): 312–315. Publisher Full Text 6. Karnak I, Ciftci AO, Tanyel FC: Hydatid cyst: an unusual etiology for a cystic lesion of the posterior mediastinum. J. Pediatr. Surg. 1998 May; 33 (5): 759–760. PubMed Abstract | Publisher Full Text 7. Eroglu A, Kurkcuoglu IC, Karaoglanoglu N, et al. : Primary hydatid cysts of the mediastinum. Eur. J. Cardiothorac. Surg. 2002; 22 (4): 599–601. Publisher Full Text 8. Janah H, Souhi H: Massive hydatid pulmonary embolism. Pan Afr. Med. J. 2014 [cited 2025 Mar 1]; 19 : 20. Publisher Full Text Reference Source Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 12 Mar 2025 ADD YOUR COMMENT Comment Author details Author details 1 Pneumology Department Ibn Nefiss, Hospital of Pneumo-Phtisiology Abderrahman Mami, Ariana, Ariana, Tunisia 2 Thoracic Surgery Department, Hospital of Pneumo-Phtisiology Abderrahman Mami, Ariana, Ariana, Tunisia Bochra Karaborni Roles: Conceptualization, Data Curation, Investigation, Methodology, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Hela Kamoun Roles: Formal Analysis, Methodology, Resources, Supervision, Validation, Visualization Hadhemi Rejeb Roles: Formal Analysis, Supervision, Validation, Visualization Imene Bouassida Roles: Data Curation, Supervision, Visualization Hanene Smadhi Roles: Data Curation, Formal Analysis, Resources, Supervision, Validation, Visualization Leila Fekih Roles: Supervision, Validation, Visualization Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 12 Mar 2025, 14:285 https://doi.org/10.12688/f1000research.162741.1 Copyright © 2025 Karaborni B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Karaborni B, Kamoun H, Rejeb H et al. Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.12688/f1000research.162741.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 12 Mar 2025 Views 0 Cite How to cite this report: Ulas AB. Reviewer Report For: Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.5256/f1000research.178992.r391486 ) The direct URL for this report is: https://f1000research.com/articles/14-285/v1#referee-response-391486 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 Jun 2025 Ali Bilal Ulas , Department of Thoracic Surgery, Ataturk University, Erzurum, Turkey Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.178992.r391486 This is a well-written and timely case report describing an unusual presentation of a mediastinal hydatid cyst in a 34-year-old male. Given that mediastinal involvement by Echinococcus granulosus is rare (with estimates ranging from 0.1% to 4% of all hydatid ... Continue reading READ ALL This is a well-written and timely case report describing an unusual presentation of a mediastinal hydatid cyst in a 34-year-old male. Given that mediastinal involvement by Echinococcus granulosus is rare (with estimates ranging from 0.1% to 4% of all hydatid disease cases), this report contributes valuable insight into a less commonly discussed localization of a significant parasitic infection. The clinical presentation, imaging findings, surgical management, and histopathological confirmation are clearly outlined. The case adds to the existing body of literature on rare presentations of echinococcosis, particularly in endemic regions like Tunisia. It also serves as a reminder for clinicians to consider atypical localizations when evaluating mediastinal masses, especially in patients from or residing in endemic areas. While the manuscript is strong overall, there are several points where clarification or expansion would enhance its scientific value and utility to readers: There is no mention of prior travel history, exposure to animals, or contact with endemic areas important in hydatid disease. No family history or environmental risk factors are discussed, which would help contextualize the case in an endemic region like Tunisia. The patient presented with bilateral basithoracic pain and exertional dyspnea. Could the authors elaborate on how they differentiated between pulmonary, pleural, cardiac, and mediastinal causes of his symptoms? Could you provide a brief explanation of hydatid serology testing? What specific test was used such as ELISA, indirect hemagglutination, and what was the titer? Were any cardiac enzymes checked to rule out myocardial involvement or injury? This would be important given the proximity of the cyst to the pericardium. The CT scan showed multiple loculations, which is unusual for typical hydatid cysts. Could the authors comment on whether this feature raised concern for other diagnoses such as lymphoma, tuberculosis, thymic cyst? The MRI confirmed the multivesicular nature of the lesion, which is consistent with hydatid disease. However, it would be helpful to know if DWI sequences or ADC mapping were used to assess diffusion characteristics, which can aid in differentiating cyst types. Please, clarify the relationship between the mediastinal cyst and the pericardial effusion. Is the effusion likely due to inflammation from the cyst, or could it represent a complication such as partial rupture? The authors mention a right lateral thoracotomy and dissection of lymph nodes at stations 2R and 4R. However, more details about the surgical approach such as whether the pericardium was opened, how the cyst was managed to avoid spillage, and whether adjuvant therapy such as albendazole was administered would strengthen the report. Since the patient had two hepatic hydatid cysts, did the team consider addressing those surgically or medically during the same admission? If not, what was the rationale? The postoperative course was uncomplicated, but no follow-up duration was specified. Was the patient followed up clinically and/or radiologically after discharge? If so, what was the timeline and outcome? The discussion could benefit from a brief comparison with previously published cases, especially regarding location, symptoms, imaging features, surgical outcomes, and recurrence rates. Including a sentence or two about medical management options such as albendazole and their role in pre or postoperative care would add practical value for clinicians managing such cases. The CRP level is stated as 240 mg/L, which indicates a significant inflammatory response. It would be useful to compare this with reference ranges and perhaps note if CRP normalized postoperatively. Even a few weeks of follow-up would provide reassurance about the safety and efficacy of the intervention. “Multivesicular” and “multilocular” are sometimes used interchangeably; clarify whether these terms refer to daughter cysts or septations. Some minor grammatical improvements could be made for example, “bilaterally basithoracic pain” should be “bilateral basithoracic pain.” The figure legend for Figure 1 is concise, but including a brief description of the MRI sequences used such as T2-weighted, contrast-enhanced T1-weighted would improve the interpretability of the image. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Thoracic surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ulas AB. Reviewer Report For: Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.5256/f1000research.178992.r391486 ) The direct URL for this report is: https://f1000research.com/articles/14-285/v1#referee-response-391486 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Mihetiu A. Reviewer Report For: Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.5256/f1000research.178992.r370867 ) The direct URL for this report is: https://f1000research.com/articles/14-285/v1#referee-response-370867 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Mar 2025 Alin Mihetiu , Faculty of Medicine, County Clinical Emergency Hospital of Sibiu, Lucian Blaga University of Sibiu, Sibiu, Romania Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.178992.r370867 This case report analyzes a rare location of hydatid pathology, that of the mediastinum. Although the case presentation is detailed in terms of imaging and preoperative diagnosis, details regarding the technique used and the attitude towards the two hydatid ... Continue reading READ ALL This case report analyzes a rare location of hydatid pathology, that of the mediastinum. Although the case presentation is detailed in terms of imaging and preoperative diagnosis, details regarding the technique used and the attitude towards the two hydatid cysts are not specified. Were they approached, if so in what manner? Also, the information in the discussions is exhaustive, at least data on other types of surgical approach (thoracoscopic, robotic or image-guided) being necessary. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: General Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Mihetiu A. Reviewer Report For: Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.5256/f1000research.178992.r370867 ) The direct URL for this report is: https://f1000research.com/articles/14-285/v1#referee-response-370867 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 12 Mar 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 12 Mar 25 read read Alin Mihetiu , Lucian Blaga University of Sibiu, Sibiu, Romania Ali Bilal Ulas , Ataturk University, Erzurum, Turkey Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ulas A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 Jun 2025 | for Version 1 Ali Bilal Ulas , Department of Thoracic Surgery, Ataturk University, Erzurum, Turkey 0 Views copyright © 2025 Ulas A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a well-written and timely case report describing an unusual presentation of a mediastinal hydatid cyst in a 34-year-old male. Given that mediastinal involvement by Echinococcus granulosus is rare (with estimates ranging from 0.1% to 4% of all hydatid disease cases), this report contributes valuable insight into a less commonly discussed localization of a significant parasitic infection. The clinical presentation, imaging findings, surgical management, and histopathological confirmation are clearly outlined. The case adds to the existing body of literature on rare presentations of echinococcosis, particularly in endemic regions like Tunisia. It also serves as a reminder for clinicians to consider atypical localizations when evaluating mediastinal masses, especially in patients from or residing in endemic areas. While the manuscript is strong overall, there are several points where clarification or expansion would enhance its scientific value and utility to readers: There is no mention of prior travel history, exposure to animals, or contact with endemic areas important in hydatid disease. No family history or environmental risk factors are discussed, which would help contextualize the case in an endemic region like Tunisia. The patient presented with bilateral basithoracic pain and exertional dyspnea. Could the authors elaborate on how they differentiated between pulmonary, pleural, cardiac, and mediastinal causes of his symptoms? Could you provide a brief explanation of hydatid serology testing? What specific test was used such as ELISA, indirect hemagglutination, and what was the titer? Were any cardiac enzymes checked to rule out myocardial involvement or injury? This would be important given the proximity of the cyst to the pericardium. The CT scan showed multiple loculations, which is unusual for typical hydatid cysts. Could the authors comment on whether this feature raised concern for other diagnoses such as lymphoma, tuberculosis, thymic cyst? The MRI confirmed the multivesicular nature of the lesion, which is consistent with hydatid disease. However, it would be helpful to know if DWI sequences or ADC mapping were used to assess diffusion characteristics, which can aid in differentiating cyst types. Please, clarify the relationship between the mediastinal cyst and the pericardial effusion. Is the effusion likely due to inflammation from the cyst, or could it represent a complication such as partial rupture? The authors mention a right lateral thoracotomy and dissection of lymph nodes at stations 2R and 4R. However, more details about the surgical approach such as whether the pericardium was opened, how the cyst was managed to avoid spillage, and whether adjuvant therapy such as albendazole was administered would strengthen the report. Since the patient had two hepatic hydatid cysts, did the team consider addressing those surgically or medically during the same admission? If not, what was the rationale? The postoperative course was uncomplicated, but no follow-up duration was specified. Was the patient followed up clinically and/or radiologically after discharge? If so, what was the timeline and outcome? The discussion could benefit from a brief comparison with previously published cases, especially regarding location, symptoms, imaging features, surgical outcomes, and recurrence rates. Including a sentence or two about medical management options such as albendazole and their role in pre or postoperative care would add practical value for clinicians managing such cases. The CRP level is stated as 240 mg/L, which indicates a significant inflammatory response. It would be useful to compare this with reference ranges and perhaps note if CRP normalized postoperatively. Even a few weeks of follow-up would provide reassurance about the safety and efficacy of the intervention. “Multivesicular” and “multilocular” are sometimes used interchangeably; clarify whether these terms refer to daughter cysts or septations. Some minor grammatical improvements could be made for example, “bilaterally basithoracic pain” should be “bilateral basithoracic pain.” The figure legend for Figure 1 is concise, but including a brief description of the MRI sequences used such as T2-weighted, contrast-enhanced T1-weighted would improve the interpretability of the image. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Thoracic surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Ulas AB. Peer Review Report For: Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.5256/f1000research.178992.r391486) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-285/v1#referee-response-391486 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Mihetiu A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Mar 2025 | for Version 1 Alin Mihetiu , Faculty of Medicine, County Clinical Emergency Hospital of Sibiu, Lucian Blaga University of Sibiu, Sibiu, Romania 0 Views copyright © 2025 Mihetiu A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This case report analyzes a rare location of hydatid pathology, that of the mediastinum. Although the case presentation is detailed in terms of imaging and preoperative diagnosis, details regarding the technique used and the attitude towards the two hydatid cysts are not specified. Were they approached, if so in what manner? Also, the information in the discussions is exhaustive, at least data on other types of surgical approach (thoracoscopic, robotic or image-guided) being necessary. Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise General Surgery I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Mihetiu A. Peer Review Report For: Case Report: Atypical Localization of a Pulmonary Hydatid Cyst [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :285 ( https://doi.org/10.5256/f1000research.178992.r370867) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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