We report a 35-year-old man who presented to us with features suggestive of a tension pneumothorax. However, insertion of a chest tube did not result in any signs of improvement. Further investigation demonstrated that he had a ruptured hydatid cyst. He underwent an emergency thoractomy and excision of the cyst. Ruptured hydatid cyst should be considered as a possibility in patients who present with sudden onset respiratory distress and hypoxia in geographical areas where the disease may be prevalent.
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