Despite extensive infection control measures against parasitic diseases, hydatid disease, caused by Echinococcus granulosus, still occurs in a minor group of our population. If the infection is not treated adequately, it goes on to developing life-threatening complications, one of which is hepatopulmonary fistula. These complications usually warrant early surgical intervention, or else may lead to extensive sepsis and ultimately death. We discuss the case of an elderly female suffering from pulmonary hydatid disease, further complicated by a hepatopulmonary fistula and underwent surgical treatment. This case emphasises the importance of early recognition of pulmonary hydatid disease given its atypical nature of presentation before the disease is further exacerbated by this aggressive complication. Furthermore, it is imperative to incorporate radical surgery as the first-line treatment in established hepatopulmonary fistula, in order to prevent further clinical deterioration and curative outcome.

Pulmonary carcinosarcoma represents a category of extremely rare tumours accounting for 0.1% of all lung malignancies. It is defined as a poorly differentiated non-small-cell carcinoma that contains a component of sarcoma or sarcoma-like elements. These biphasic tumours typically have a poor prognosis due to late diagnosis and early metastases. Preoperative tissue diagnosis is usually difficult due to the heterogeneity of the tumour, with biopsies often just reflecting one element of the tumour. By means of a case illustration and review of the literature, we discuss the optimal management of patients with pulmonary carcinosarcoma.

Cauda equina syndrome (CES) is a relatively uncommon condition typically associated with a large space-occupying lesion within the canal of the lumbosacral spine. It is one of the few spinal surgical emergencies and its prompt diagnosis and surgical treatment are of paramount importance as, otherwise, patients could be left with permanent and disabling neurological deficits involving lower limb sensorimotor function, bladder, bowel and sexual function. Furthermore, and as a result of perceived delays in diagnosis and treatment culminating in a suboptimal functional outcome, CES carries a disproportionately high medicolegal profile. This article aims to provide a simple overview of lumbar disc prolapse, CES and its initial management in primary care.