Sahar choobtashany - Pulmonologist, Assistant professor, Clinical Research Development Unit, Shahid Rajaei, Educational&Medical Center
Nooshin Taherzadeh - (Student of Medical, School of Medicine, Alborz university of Medical sciences, Karaj, Iran).
Armin Khavandegar - (Student of Medical, School of Medicine, Alborz university of Medical sciences, Karaj, Iran).

Introduction:Human cystic echinococcosis (CE) is worldwide parasitic infection in which the larval cysts of Echinococcus granulosus develop in some tissue or organ, very often in the liver and/or the lungs. Hydatid infestation of the lung can be primary or secondary. Hydatidosis of different location, particularly the liver, may be associated. special form is so-called multiple malignant pulmonary hydatidosis, which causes progressive respiratory deficiency and right ventricular failure. On very rare occasions cyst may be found inside the pulmonary artery, the result of the rupture of an intracardic cyst or more rarely dissemination from hepatic infection. Surgery is usually the therapeutic approach of choice.Case report:In 1391, 70-year-old man presented with dyspnea and hemoptysis due to pulmonary embolism.10 years ago, he had had multiple hydatid cysts in both lungs and cyst in liver. Patient presented CTEPH and his pulmonary artery pressure was (PAP) 80. Serologic tests results for hydatid cyst were positive. His liver enzymes were elevated. Pulmonary CT angiography showed presence of different size nodular and sub segmental opacities in both lungs and some hilar and mediastinal adenopathies. Also pulmonary embolism revealed on CT angiography.Conclusion:In three of four cases the pulmonary hydatid cyst in is single one. IN this patient we recognized multiple cysts in both lungs. Based on our finding from CT angiography and seropositivity for anti-echinococcal antibodies pulmonary embolism may be the result of CE. Treatment is essentially surgical but in this very severe case surgery did not respond well. We also prescribed warfarin in order to dissolving clots caused CTEPH.

echinococcosis, hydatid cyst, multiple pulmonary cyst, pulmonary embolism.