Hydatid cyst-related deaths: a structured autopsy-based forensic analysis of pathological phenotypes and fatality mechanisms.

Hydatid cyst-related mortality is rare and diagnostically challenging in forensic practice, particularly when cystic echinococcosis remains clinically unrecognized until death. This study aimed to characterize hydatid cyst-related deaths through integrated assessment of clinical course, macroscopic morphology, histopathology, and mechanism of death. We retrospectively reviewed 32 hydatid cyst-related deaths evaluated by the First Specialized Board of the Council of Forensic Medicine of Türkiye between 2013 and 2024. Demographic and clinical characteristics, organ involvement, macroscopic cyst features, histopathological findings, and certified mechanisms of death were assessed. Macroscopic and histopathological findings were categorized using predefined morphological classifications, and clinicopathological associations were analyzed. The median age was 27.5 years, and 71.9% were male. Hepatic involvement was present in 93.8%, while hydatid disease had not been diagnosed before the fatal event in 84.4%. Anaphylactic shock was the predominant fatal mechanism (59.4%), followed by sepsis/multiorgan failure (21.9%), hydatid-related sudden death without further mechanistic specification (9.4%), pulmonary hydatid embolism (6.3%), and direct cardiac hydatid-related sudden death (3.1%). Intact or tense cysts predominated among macroscopically evaluable cases (73.3%), whereas complete rupture was identified in 16.7%. The secondary infected histopathological phenotype was associated with sepsis-related death (OR 18.0; 95% CI 1.54-210.6; p = 0.025). Hydatid cyst-related deaths occur through distinct clinicopathological pathways, with anaphylactic shock predominating. Complete macroscopic rupture is not required for fatal hypersensitivity reactions. Integrating gross morphology, histopathology, systemic autopsy findings, and clinical context may improve postmortem mechanistic interpretation.