Cardiac hydatid cyst in left ventricular free wall

Abstract

SummaryWe report a rare case of a cardiac hydatid cyst that was incidentally found during routine work up for a redo-CABG and was picked up on echocardiography and confirmed by magnetic resonance imaging and, after successful removal, further confirmed by histopathology. The report emphasizes the importance of early and urgent surgery for such cardiac hydatid cysts whenever discovered to prevent fatal and unexpected death. Cardiac hydatidosis is a most infrequent type, in comparison with hydatidosis of the liver (65%) and lung (25%).Learning points Hydatidosis or cystic echinococcosis is caused by infection with the metacestode stage of the tapeworm Echinococcus (family Taeniidae). The adult tapeworm is usually found in dogs or other canines; the tapeworm eggs are expelled in the animal's feces and humans become infected after ingestion of the eggs. The initial phase of primary infection is asymptomatic.Cardiac hydatidosis is extremely rare, more commonly the liver and lungs are affected.Morbidity from heart echinococcosis in men is three times higher than that in women. Solitary cysts occur in almost 60% of the cases; the most frequent location is the ventricular myocardium and they are usually subepicardially located, hence they rarely rupture in the pericardial space. The left ventricle is damaged twofold to threefold more frequently than the right one.The diagnosis of echinococcosis in heart can be divided into two steps: detection of the cyst and its identification as echinococcus. It is based on serological reactions, echocardiography, X-ray, computerized tomography, and/or magnetic resonance imaging.The most dangerous complication of cardiac echinococcosis is cyst perforation. After cyst perforation three quarters of the patients die from septic shock or embolic complications.It is very important to understand that chemotherapy may lead to cyst death, and destruction of its wall and result in cyst rupture. Therefore, no germicide must be administered before surgical removal.

Incidental finding of heart and brain echinococcosis in a patient with carbon monoxide poisoning

“…According to the aforementioned study [10], it is thought that haematogenous spread is the main method of the distribution of cardiac echinococcosis, and the direct extension method from adjacent structures must be questioned. Other rare cases were also reported in the literature, with localization in the left atrium [11], right ventricle [12] and left ventricular wall [13].…”

Atypical chest pain in a patient with hydatid cyst of the interventricular septum

“…The reason for which could be attributed to the fact that this heart chamber has the maximum myocardial mass and rich blood supply. 3 The interventricular septum involvement occurs only in 5%-9%. 4 5 The cyst usually grows slowly and most of the time, the patients are asymptomatic.…”

Cardiac Hydatid Cyst: First Ever Documented Case in Bangladesh

“…Echocardiography findings vary according to the sites of the cysts 8 . Echocardiography is the simple and useful diagnostic tool of cardiac hydatid cysts 8 .Most of the cases reavealed as intra-myocardial tumour on Echocardiography 1,12 .But our report reavealed as thrombus burden in the LA, MPA & RPA.…”

“…The diagnosis of cardiac hydatid disease is based on the combination of clinical suspicion, serologic tests and cardiac imaging. Echocardiography is highly sensitive and specific tool for the diagnosis of hydatidcysts 8 and positive serological tests can help the diagnosis of this disease.…”