Right ventricular hydatid cyst causing recurrent pulmonary emboli

Pediatric hydatid cyst with ventricular aneurysm and surgical treatment with dor procedure, case report

BACKGROUND

Cardiac involvement of hydatid cyst disease (HCD) is a rare presentation but may lead to life-threatening complications such as cyst rupture and should be treated surgically.

METHODS

A 10-year-old male patient with cranial and complicated cardiac HCD lesions that caused lower extremity peripheral arterial occlusion and aneurysmatic dilatation in the left ventricular apex is presented.

RESULTS

Although the patient was in the pediatric age group, the Dor procedure was successfully applied to preserve the ventricular geometry. The Dor procedure for a ventricular aneurysm caused by a cardiac hydatid cyst (CHC) was rarely applied in the pediatric age group.

CONCLUSION

In conclusion, this case differs from other CHCs previously reported in the literature due to the advanced stage of the disease, atypical clinical presentation, and rare complications despite the young age of the case. The surgical method used in treating the patient makes the subject more interesting.

Atypical parasitic lesions in slaughtered cattle in Southern Brazil

In this study, we described the morphological features and unusual presentations of hydatidosis, fasciolosis, and eosinophilic myositis caused by Sarcocystis species diagnosed at the slaughterhouse lines. Twenty-seven samples of atypical parasitic lesions from distinct cattle were evaluated, of which 12 corresponded to hydatidosis, 11 to fasciolosis, and 4 to eosinophilic sarcocystosis. Hydatid cysts were observed mainly in the heart, with all cases involving the left ventricle. Fasciolosis lesions involved mainly the lungs, and were characterized by a focal nodular elevated area involving the edges of the lobes. Intralesional trematodes were observed in three cases. Sarcocystosis lesions were observed in four cases, and lesions were primarily located in the skeletal and cardiac muscles. Grossly, they presented as focal or focally extensive streaks, patches, or numerous nodules that were greenish to mildly yellowish. Histologically, all the cases had intralesional ruptured cysts of Sarcocystis that were associated with severe eosinophilic myositis and myocarditis. Parasitic lesions in atypical locations and/or with aberrant responses should be promptly identified because it may mistakenly diagnosed as other potentially zoonotic diseases, such as cysticercosis and tuberculosis.

Hydatid cyst of the heart with mitral valve stenosis; Case report

Hydatid cyst of the heart is very rare, the left ventricle is the commonest site of myocardial involvement due to dominant left coronary vessels and thicker wall. Isolated cardiac involvement is extremely rare. Patients may be quite asymptomatic but the cyst may cause palpitation, dyspnea, chest pain, or when ruptured in to the cardiac or pericardial cavities may cause emergency presentations like anaphylactic reactions, sudden collapse due to pericardial tamponade or even sudden death.

A middle age female presented with exertional shortness of breath for 2 years. Echocardiography showed mitral valve stenosis. Computerized tomography scan of the chest showed a big complicated hydatid cyst arising from the wall of the right ventricle. Median sternotomy was done with excision of the hydatid cyst, and repair of mitral stenosis by commissurotomy. The patient received three cycles of albendazole for three months.

Surgery is the best options of treatment of cardiac hydatid disease, when the disease is affecting the pericardium complete excision may be possible, but when the myocardium is involved it may be difficult or even impossible to do complete excision, in this situation the cyst contents should be evacuated completely, preventing spillage is very mandatary to prevent recurrence. Care must be taken to avoid damage to the conductive system, the papillary muscles, the aortic and the mitral valves. Medical treatment with anthelminthic medications is used after surgery to reduce the recurrence rate.

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Hydatid cyst of the heart is a very rare clinical finding.

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It may be encountered during any other kinds of cardiac surgeries.

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The heart may be primarily affected of may be secondary to other organ involvement.

Acute limb ischemia caused by ruptured cardiac hydatid cyst - A case report

INTRODUCTION

Acute limb ischemia is a sudden decrease in limb perfusion that threatens the viability of the limb. Complete or even partial occlusion of the arterial supply to a limb can lead to rapid ischemia and poor functional outcomes within hours. In human echinococcosis cardiac involvement is a rare presentation, it may lead to life-threatening complications including cyst rupture; anaphylactic shock; tamponade; pulmonary, cerebral or peripheral arterial embolism. Cardiac hydatid cyst (CHC) may have different presentation include acute lower limb ischemia secondary to embolization from a ruptured cyst.

CASE PRESENTATION

We report an 18-year old male healthy building worker while he was working who presented with sudden onset acute right lower limb pain and paresthesia caused by rupture of primary CHC which managed as a surgical emergency.

DISCUSSION

Clinical presentation of ruptured of CHC depends on the specific location of the ruptured cyst that interferes and mobilization of daughter cyst that logged in vascular system with the function of the surrounding cardiac structures like our case that present with embolization of daughter cyst into the right external iliac artery which leads to acute limb ischemia.

CONCLUSION

Cardiac hydatid cyst is a rare finding with a wide range of signs and symptoms. We are reporting this case to underline that cardiac hydatidosis should be considered as a differential diagnosis in young patients who suddenly develop acute limb ischaemic without a history of both cardiac diseases and trauma that lives in endemic regions of hydatidosis.

Infected Myocardial Hydatid Cyst Imitating Pericardial Cyst

Pericardial hydatid cyst was diagnosed by 2-dimensional echocardiography and magnetic resonance imaging in a 25-year-old female. At operation, an infected myocardial hydatid cyst was found on the lateral wall of the left ventricle.

Hydatid Cyst on Right Ventricular Posterior Wall

A 14-year-old boy was investigated for unexplained tachycardia and multiple pulmonary emboli demonstrated by computed tomography. A right ventricular hydatid cyst was diagnosed by echocardiography and successfully excised under cardiopulmonary bypass.

Embolization of Ruptured Hepatic Hydatid Cyst to Pulmonary Artery in an Elderly Patient: Multidetector computed tomography findings

Pulmonary embolism due to hydatid disease is an unusual condition resulting from the rupture of a hydatic heart cyst or the opening of liver hydatidosis into the venous circulation. A 78-year old male patient complaining of dyspnea, cough and severe chest pain was admitted to our emergency department. A multidetector computed tomography of the chest revealed the presence of multiple nodules in both lungs especially in left and multiple hypodense filling defect in left main pulmonary artery and its branches. In addition, coronal reformatted multidetector computed tomography images also showed two hypodense cystic parenchymal masses on the left lobe of the liver with a cystic embolus in the right atrium. Pulmonary embolism should be kept in mind in patients who have hepatic hydatidosis if suddenly chest pain and dyspnoea occurs, especially in regions where hydatidosis is endemic.

Combined medical and surgical treatment of intracardiac hydatid cysts in 11 patients

OBJECTIVES

Echinococcosis is a human parasitic disease common in sheep-rearing regions, which is caused by the larval stage of Echinococcus granolosus and can involve any heart region. We report 11 cases of cardiac hydatidosis who were treated medically and surgically.

PATIENTS AND METHODS

Eleven patients diagnosed with cardiac echinococcosis were referred to the Cardiac Surgery Department of Shahid Madani Hospital from 1992 to 2004. Symptoms included dyspnea, palpitation, limb ischemia, fever, weight loss, hemiplegia, and loss of consciousness. Patients underwent surgical removal of the cyst followed by medical treatment until the titer of echinococcus hemaglutination test came to normal.

RESULTS

Hospital stay and recovery time were uneventful in nine patients. One patient died due to acute renal failure before hospital discharge (9%) and another patient experienced cerebral hydatidosis 12 months after surgery (probably due to cyst embolism). The other nine patients had no complications during five years of follow-up.

CONCLUSION

Surgical excision using cardiopulmonary bypass combined with medical therapy provides the most optimal treatment for cardiac echinococcosis.

Left ventricular epicardial hydatid cyst compressing the left circumflex artery

Cardiac hydatid is a rare disease with varied presentation. We report a unique case of left ventricular epicardial hydatid cyst causing left circumflex artery compression. Cardiac hydatids have to be surgically treated on diagnosis because of the high risk of catastrophic rupture. We discuss the surgical principles and the other adjuncts to avoid recurrence.

[Cardiac hydatidosis with dissemination to the pulmonary parenchyma and the pulmonary artery]

Multiple thoracic hydatic disease involving a cardiac and pulmonary localization is exceptional and prognosis is poor. We report a case in a 21-year-old male who presented repeated episodes of hemoptysis. The chest x-ray showed multiple opacities. The thoracic computed tomography and echocardiography visualized cystic formations in the heart and the pulmonary arteries. Hydatic serology was strongly positive. Medical treatment with albendazole was given but the patient died from massive hemoptysis before the cardiac and pulmonary artery cysts could be removed surgically (a procedure which requires extracorporeal circulation). A hydatic cyst of the pulmonary artery is usually secondary to a cardiac localization. The risk is dissemination into the pulmonary and eventually systemic circulation. An arterial localization must be carefully ruled out in all patients with multiple or cardiac hydatidosis. Treatment is surgical to avoid dissemination.

Off-pump technique for the treatment of ventricular myocardial echinococcosis

BACKGROUND

This study was planned to investigate the off-pump operability of ventricular myocardial Echinococcosis, which has no close relation with the cardiac chambers.

METHODS

Twenty patients with cardiac echinococcosis, and 2 patients with isolated pericardial echinococcosis were operated on. Hydatid cysts were located in the ventricular wall in 17 patients and 10 of these 17 patients were operated without cardiopulmonary bypass. We present these 10 patients in this report. We used transesophageal echocardiography (TEE) and peroperative surface echocardiography (PSE) to determine the relation of cysts with cardiac chambers. The cysts were aspirated for diagnosis and to facilitate the dissection. Cyst cavities were left open in all cases.

RESULTS

We did not observe any early complication and in long-term follow-up only one patient underwent reoperation 68 months after her first operation due to reoccurrence.

CONCLUSIONS

Ventricular myocardial echinococcosis without relation with the cardiac chambers can be operated without using cardiopulmonary bypass with the aid of TEE, PSE, and controlled cyst fluid aspiration.

Eustachian valve cyst

Transesophageal echocardiography provides high resolution of intracardiac structures. One potential problem is the misdiagnosis of previously unrecognized benign cardiac structures as malignant processes, leading to unnecessary surgical procedures. We describe an unusual case of benign intracardiac eustachian valve cyst monitored over 2 years.

Hydatid pulmonary emboli

A case of secondary hydatosis, initially misdiagnosed as pulmonary metastases, is presented. The dissemination of hydatid cysts within the lungs in this case was the consequence of direct rupture of a hepatic hydatid into the inferior vena cava. A brief overview of the pathophysiology of hydatid disease, including a discussion of the types of hydatid rupture (contained, communicating and direct), is presented.

Cardiac hydatid cysts with intracavitary expansion

BACKGROUND

Hydatid cyst disease is a significant health problem for undeveloped and developing countries. Although cardiac involvement is rare, early diagnosis and treatment of this situation is important.

METHODS

To investigate the long-term outcome of patients who underwent operation for cardiac hydatid cysts with intracavitary expansion, we reviewed 8 patients who had cardiac hydatidosis and who underwent operation in our institution between January 1988 and November 1999. All patients presented with intracavitary protrusion of the cysts. Seven patients were women. The mean age was 33 +/- 14.3 years with a range of 17 to 55 years. The cysts were located on the right ventricular outflow tract (2 patients), right midventricular part of the muscular septum, left atrial free wall and apical portions of the right (2), or left (2 patients) ventricle. Standard cardiopulmonary bypass and crystalloid antegrade cardioplegia with aortic cross-clamping were used in all patients. In one, with right ventricular hydatid cyst, we used cardiopulmonary bypass with femoral cannulation and total circulatory arrest at less than 18 degrees C systemic hypothermia. This patient, who was arrested because of pulmonary emboli could not be weaned from cardiopulmonary bypass and died.

RESULTS

The cystic cavity was cleaned and closed with multiple pursestring sutures in 4 patients. In 2, cardiac and cystic cavities were united by partially resecting part of the cyst facing the cavity. In another patient, a left ventricular patch plasty was performed after removal of the cystic material in the left ventricle. Mebendazole was used postoperatively in all patients. Except for 1 patient who died, all were discharged without postoperative complications. The mean follow-up was 7.5 +/- 5 years. There was no late cardiac mortality or recurrence.

CONCLUSIONS

Cardiac hydatid cysts with intracavitary expansion should be treated surgically without delay. Gentle handling of the heart during cardiopulmonary bypass minimizes operative risk. All patients should be investigated for systemic cysts.

Unusual recurrence of hydatid cysts of the heart: report of two cases and review of the clinical and surgical aspects of the disease

In cardiac echinococcosis, a hydatid cyst most frequently forms either solely in the heart or in the pericardium, but there are several reports of cysts forming in the liver or lung or in both. In two cases reported here, both patients developed cysts in new sites after one or more previous surgeries for hydatid cyst removal. In Case 1, the patient first underwent spleenectomy and resection of multiple cysts with no evidence of a cyst in the heart; 3 years later, there was no sign of Echinococcus in the liver, but a large inframyocardial cyst had damaged the left ventricle. In Case 2, the patient first underwent surgery to remove cysts from the pericardium, 2 years later from the anterior wall of the left ventricle, and, finally, 8 months after this second operation, from the left atrium also with no evidence of cyst formation anywhere else in the heart at the time of surgery. These cases emphasize the need for thorough and frequent reevaluation to detect new hydatid cyst formation in the heart and elsewhere caused by the Echinococcus organism.

Ruptured Hydatid Cyst of the Right Ventricular Outflow Tract

A 12-year-old boy who presented with recurrent syncope was diagnosed to have a hydatid cyst of the right ventricular outflow tract. He underwent emergency surgery for cyst rupture but died due to pulmonary embolism and right heart failure.

A multivesicular cardiac hydatid cyst with hepatic involvement

Cardiac hydatid cyst is an uncommon lesion, mostly caused by Echinococcus granulosus. Occurrence of the disease in man appears to be limited geographically to areas where close and continuous contact exists between domesticated carnivores such as dogs and ungulates such as cattle and sheep. Generally cardiac hydatid cysts are univesicular. Here we report our clinical and surgical experience of treatment in a case of a multivesicular cardiac hydatid cyst with hepatic involvement.

Echinococcosis of the heart: clinical and echocardiographic features in 19 patients

We describe clinical and echocardiographic features in 19 patients with cardiac echinococcosis. Wide variability in the location and number of cysts inside cardiac cavities, septum, and pericardium is observed. The central role of two-dimensional echocardiography in making the diagnosis is stressed. This report has a significant clinical value in view of the large number of cases of a relatively rare condition.

Pericardial hydatid cyst with a fatal course

Cases with cardiac hydatid cyst disease are uncommon, being approximately 0.2-2% of all cases. Most cardiac hydatid cysts are located in the interventricular septum or left ventricular wall. Pericardial location is very rare. We report on a 12 year old girl with pericardial hydatid cyst disease who was otherwise asymptomatic, having no cardiac symptomatology. Unfortunately the course of her disease was fatal. This is the first report of uncommon localized hydatid disease with a fatal outcome.

Cardiac hydatid cyst in a child: diagnostic value of echocardiography and magnetic resonance imaging

Cardiac hydatid cyst is extremely rare in children. We report a case of a cardiac echinococcal cyst in an 11 year old boy, diagnosed by two-dimensional echocardiography and magnetic resonance imaging (MRI). The cyst was located in the posterior wall of the left ventricle and was excised surgically. Echocardiographic and MRI findings are discussed.

Surgical Treatment of Cardiac Echinococcosis: Report of Ten Cases

From 1977 to July 1994, 10 patients underwent operation for cardiac cysts in the Department of Cardiovascular Surgery of Türkiye Yüksek Ihtisas Hospital. The ages of the patients ranged from 10 to 39 years (mean 25.2 ± 8.82). Nine patients had cardiac and pericardial cysts, and the first patient of this series had two pericardial cysts. One patient died in the early postoperative period due to rupture of the interventricular septum. Hospital mortality was 10% (1/10). Late follow-up data were obtained for 8 of the 9 hospital survivors, and no recurrence was found.

Primary cardiac echinococcosis in childhood. Case report

Cardiac echinococcosis is rare and usually occurs in adults. In a 12-year-old boy a left ventricular hydatid cyst was diagnosed by two-dimensional echocardiography and computed tomography and the cyst was surgically removed.