Giant Cardiac Hydatid Cyst in Children: Case Report and Review of the Literature

Abstract

Cardiac echinococcus is a rare affliction of the heart caused by the tapeworm Echinococcus granulosus. Primary echinococcosis of the heart represents 0.5–2% of all hydatid disease cases in endemic regions. It evolves slowly, explaining its rarity in children. We report the case of a 11-year-old child affected by a giant cardiac cyst of the left ventricle (LV). The patient underwent cardiac surgery and medical treatment. A retrospective review of the current literature was realized. We found 18 cases: the mean age was 11-years old. Nine cysts were localized in the LV, four in the interventricular septum, three in the right ventricle, and two in the right atrium. All underwent surgery except six patients. Routine echocardiographic screening may be useful in endemic regions where infestation is common. Cardiac echinococcus should be diagnosed in the early and uncomplicated stages and be removed surgically even in asymptomatic patients.

Diagnosis and treatment of cardiac echinococcosis

“…Importantly, patients with cardiac echinococcosis show rarely asymptomatic to more often life-threatening disease courses, the latter most likely induced by an acute hydatid cyst rupture. Importantly, asymptomatic patients are assumed to represent a large proportion among all CE patients; however, patients with cardiac echinococcosis often appear symptomatic but exact numbers are not available to date 14 17. In addition to cardiac symptoms such as chest pain, dyspnoea, recurrent syncope attacks, palpitations as consequences of cardiac arrhythmias and new detected heart murmurs in the later course of the disease, patients with cardiac echinococcosis can show infection-associated symptoms such as coughing or fever at the beginning of the disease 14 18–20.…”

“…However, to date the sensitivity of ELISA in case of cardiac echinococcosis manifestation is statistically insufficiently investigated. But from previously reported cases, it can be speculated that a cardiac manifestation of CE is most likely accompanied by multiple dissemination 14. Importantly, due to the low specificity of the antibody screening tests that can be false positive in patients suffering from liver cirrhosis or malignancies, confirmatory assays such as an immunoblot (Western blot) can be performed 1 2.…”

“…In contrast, in seronegative patients the verification of cardiac hydatid cysts using imaging methods is sufficient to justify a drug and surgical treatment. The validation of cardiac hydatid cysts can be performed by transthoracic echocardiography (TTE) and trans-oesophageal echocardiography (TEE), MRI and CT 14 15 17 27. In the diagnosis and localisation of CE, ultrasound has become the current state-of-the-art method because ultrasound is almost available everywhere and highly cost-effective 15 27.…”

“…While the multiple cysts during AE often only allow a palliative medical therapy, the therapeutic standard for CE with cardiac manifestation is the curative surgical R0 resection of the hydatid cyst(s) 2 14 15 17 27. In case of refusing surgical removal by the patient or other reasons that prohibit a surgical treatment, two alternative treatment options are available (I and II).…”

“…A median sternotomy and also a right-sided thoracotomy are accepted operative accesses paths 14. Whereas atrial-located and ventricular-located hydatid cysts can be reached directly by opening the cardiac cavities, the resection of intraseptal cysts always appears challenging.…”