Bilateral giant pulmonary hydatid cysts in a toddler presenting as severe pneumonia: a risk-adapted staged surgical approach.

Background: Pulmonary hydatid disease is common in endemic regions, yet bilateral giant cysts in toddlers are exceptionally rare and may mimic severe pneumonia. Their management is challenging, particularly in physiologically vulnerable children. Case presentation: We report a 32-month-old girl presenting with fever, progressive cough, and severe respiratory distress. Imaging revealed four large pulmonary hydatid cysts-three in the left lung and one in the right-complicated by superimposed bacterial infection and hypoxemia. Albendazole therapy (15 mg/kg/day) was initiated, and a risk-adapted, staged surgical plan was selected due to low body weight, poor nutritional status, and limited respiratory reserve. The patient underwent left thoracotomy with cyst excision and capitonnage, followed by right thoracotomy 3 months later, after clinical improvement and weight gain. Recovery was uneventful, and no recurrence was observed during follow-up. Conclusion: This case highlights the diagnostic challenges of bilateral giant pulmonary hydatid cysts in toddlers and supports staged thoracotomy as a physiologically tailored strategy to minimize perioperative respiratory risk in compromised pediatric patients.