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The patient was a 38-year-old male with a history of tension pneumothorax 10 years prior, initially managed outside the authors’ center with the insertion of an intercostal tube (ICT). A second ICT was later inserted, and the patient was subsequently referred to the authors’ center. Exploration through a posterolateral thoracotomy was performed due to prolonged air leak, revealing a ruptured left lower lobe hydatid cyst, which was managed with cystectomy and capitonnage. 
 
The patient then presented with chest and back pain. Multislice CT (MSCT) of the chest showed a posterior mediastinal cyst measuring 6.7 × 4.5 cm. Additionally, triphasic CT of the abdomen revealed a focal cystic lesion in hepatic segment 8, measuring 1.4 × 1.3 cm. Based on the patient’s history, clinical presentation, and imaging findings, a diagnosis of recurrent secondary pleural hydatid cyst was made. 
 
According to guidelines, surgical intervention is recommended when the cyst size exceeds 3 cm. Preoperative administration of albendazole was not advised because it reduces the tensile strength of the fibrous cyst wall, increasing the risk of rupture and anaphylaxis. For the hepatic cyst, general surgery consultation recommended medical treatment and follow-up. 
 
The patient was prepared for uniportal video-assisted thoracoscopic surgery (VATS), with the port placed in extension to the anterior end of the previous thoracotomy. Complete mobilization of the lung from the chest wall was performed to ensure better control and localization of the cyst. Adhesions between the diaphragm and lung were dissected to ensure free mobility of the diaphragm, improving respiratory mechanics. 
 
The cyst contents were aspirated using a large-bore needle, and a scolicidal agent was injected. While hypertonic saline is preferred, diluted Betadine was used as an effective alternative. The chest cavity was irrigated with warm saline prior to opening the cyst to reduce the risk of anaphylaxis. The germinative layer was meticulously removed to minimize the risk of recurrence, and the fibrous wall was excised. A bronchial communication test was performed and found to be negative. Hemostasis was achieved, a 28Fr ICT was inserted, and the port was closed in the standard manner. 
 
The postoperative course was uneventful, with the ICT removed on the third postoperative day. The patient was discharged with albendazole therapy for three months. Follow-up CT of the chest after three months revealed no residual masses or local recurrence, with a stationary course of the hepatic cystic lesion. 

References

1. Usluer O, Kaya SO, Samancilar O, Ceylan KC, Gursoy S. The effect of preoperative albendazole treatment on the cuticular membranes of pulmonary hydatid cysts: should it be administered preoperatively? Kardiochir Torakochirurgia Pol. 2014 Mar;11(1):26-9. doi: 10.5114/kitp.2014.41926. Epub 2014 Mar 27. PMID: 26336389; PMCID: PMC4283903.
2. Keramidas D, Mavridis G, Soutis M, Passalidis A. Medical treatment of pulmonary hydatidosis: complications and surgical management. Pediatr Surg Int. 2004 Jan;19(12):774-6. doi: 10.1007/s00383-003-1031-4. Epub 2004 Jan 9. PMID: 14714132.

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