包虫病是一种人兽共患疾病，可引起多种人体疾病，其中肺包虫病较为常见。本文报道1例以胸腔积液为主要表现的肺包虫病患者。该患者为70岁女性，因“右上腹痛伴胸闷16 h”入院，胸部CT检查提示右侧液气胸、右肺膨胀不全及肺部渗出性病灶。胸腔积液呈暗红色、浑浊，李凡他试验阳性，镜检见大量纤维素性坏死物及霉菌样孢子。胸腔穿刺术后病理检查提示包虫感染可能，结合患者既往肝包虫病史、牧区居住史，经外院诊断，最终确诊为肺包虫病。肺包虫病好发于牧区儿童及青壮年，患者存在接触疫犬等流行病接触史，感染途径为经口食入被虫卵污染的食物或水。临床特征常包括咳嗽、胸痛、咯血，囊肿破裂入胸腔时则可致液气胸、胸腔积液及过敏反应。本例报道的病例为老年人，且临床表现不典型，以胸腔积液为突出特征，最终患者因感染死亡，提示临床对于包虫病疫区的类似病例应予高度关注，尤其是高龄病例。

Echinococcosis is a zoonotic disease that can cause various human diseases, among which pulmonary echinococcosis is relatively common. This paper reports one case of pulmonary echinococcosis in a patient with pleural effusion as the main manifestation. The patient was a 70-year-old female admitted to the hospital due to "right upper abdominal pain accompanied by chest tightness for 16 hours". Chest CT examination indicated right-sided hydropneumothorax, right lung atelectasis, and pulmonary exudative lesions. The pleural effusion was dark red and turbid, and the Rivalta's test was positive. Microscopic examination showed a large amount of fibrinous necrotic material and fungal-like spores. Pathological examination after thoracentesis suggested possible echinococcal infection. Considering the patient's history of hepatic echinococcosis and residence in a pastoral area, and combined with the diagnosis from an external hospital, the case was ultimately confirmed as pulmonary echinococcosis. This disease commonly occurs in children and young adults in pastoral areas, and patients have an epidemiological contact history such as contact with infected dogs. The infection is transmitted orally through ingestion of food or water contaminated with echinococcal eggs. Clinical features often include cough, chest pain, and hemoptysis. Cyst rupture into the pleural cavity can cause hydropneumothorax, pleural effusion, and allergic reactions. This reported case was an elderly patient with atypical clinical manifestations, characterized predominantly by pleural effusion. The patient eventually died due to the infection. This highlights that similar cases in echinococcosis-endemic areas should receive high clinical attention, especially among elderly patients.