Intrathoracic “Ribbon” Associated with Echinococcosis

Background: Cystic echinococcosis (CE) is an endemic parasitic zoonosis in China. In most cases, the liver is the primary organ affected. Case presentation A 26-year-old man with a 2-week history of cough, mucous sputum, and fever was examined. Absent breath sounds were noted on the left side, while the right side was normal. The patient had a history of raw meat consumption. Blood tests showed a slight increase in white blood cell count and a significant elevation in eosinophil percentage. CT revealed left lung atelectasis and hydropneumothorax. A ribbon-like lesion was seen in the pleural fluid. Bronchoscopy showed no abnormalities. Parasite screening was positive for anti-Echinococcus granulosus IgG antibody. Clinical diagnosis of pulmonary echinococcosis was confirmed, and albendazole was administered. Surgery revealed features consistent with pulmonary cystic echinococcosis. A large inner cyst was removed from the chest. Left total pneumonectomy, decortication, and treatment of bronchopleural fistula were performed. A chest tube was inserted for postoperative drainage. Pathological findings confirmed pulmonary cystic echinococcosis. The patient continued albendazole treatment post-surgery and had an uneventful recovery, remaining symptom-free at follow-up. Conclusions We report a rare case of spontaneous intrathoracic rupture of pulmonary hydatid cyst with a distinctive "ribbon-like" appearance on CT. Successful surgical excision confirmed pulmonary hydatid cysts. This emphasizes the need for imaging in unexplained coughs and supports surgical excision as crucial for symptomatic pulmonary hydatid cysts patients.