barw Judi Clinical Journal 3105-4102 2 1 2026 06 19 Video-Assisted Thoracoscopic Surgery for Bilateral Giant Pulmonary Hydatid Cysts: A Case Report and Literature Review 44 48 10.70955/JCJ.2026.06 eng Fahmi H. Kakamad College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq 0000-0002-2124-9580 Amanj Khdir Hamad German Hospital for Respiratory Diseases, Shorsh Street, Sulaymaniyah, Iraq Harem K. Ahmed Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq Ayman M. Mustafa Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Iraq Fattah H. Fattah College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq Meer M. Abdulkarim Department of Medical Laboratory Science, College of Science, Charmo University, Sulaymaniyah, Iraq Hussein M. Hamasalih Department of Nursing, Bright Technical and Vocational Institute, Sulaymaniyah, Iraq Harun Amanj Ahmed College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq Sarhang Sedeeq Abdalla Kscien Organization for Scientific Research (Middle East Office), Hamdi Street, Sulaymaniyah, Iraq Kaiwan Talib Saeed College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq Danyar O. Aziz Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq 2026 05 28 Introduction: Bilateral giant pulmonary hydatid cysts (HCs) are rare but can lead to serious respiratory complications. Despite growing interest in minimally invasive surgery, the role of Video-Assisted Thoracoscopic Surgery  (VATS) in their management remains controversial. This report describes a case of giant bilateral pulmonary HCs managed using a VATS approach. Case presentation: A 34-year-old male presented with chest discomfort, productive cough, and exertional dyspnea. Imaging revealed bilateral giant pulmonary HCs, including an uncomplicated cyst in the right upper lobe and a ruptured, infected cyst in the left lower lobe. The patient underwent single-session bi-port VATS with cyst evacuation, hypertonic saline irrigation, and closure of bronchopleural fistulae. Intraoperative culture grew Pseudomonas aeruginosa, and the patient received albendazole and culture-directed antibiotics, resulting in an uneventful recovery. Literature review: Among 12 reviewed cases of pulmonary HCs, patients’ ages ranged from 3 to 42 years, with a predominance of males (7/12). Cough was present in all cases, while dyspnea and fever were reported in 50% of the cases. Bilateral cysts were documented in 6 cases. Management included VATS alone in 5 cases, thoracotomy-based surgery in 4, hybrid approaches in 2, and conservative treatment in 1. Complications occurred in 2 cases. Albendazole therapy was administered postoperatively in 7 cases, and overall outcomes were positive, with 11 patients experiencing uneventful recovery. Conclusion: Bilateral VATS in a single session may be a feasible therapeutic approach for giant pulmonary HCs, even when complicated cysts are present.