Isolated pericardial hydatid cyst in an asymptomatic patient: a remark on its radiologic diagnosis

Concurrent intrapericardial-pulmonary hydatidosis: an unusual multisystem echinococcosis

A 46-year-old male presented with breathlessness for a few months. He had been operated twice for liver hydatid cysts and once for right pulmonary hydatid cysts at other hospitals. Now he was found to have one hydatid cyst in the upper lobe of the left lung and multiple hydatid cysts adjoining left heart border. On computed tomography (CT) scan chest and echocardiography, it was difficult to ascertain whether these cysts were pulmonary or intrapericardial. Left ventricular ejection fraction (LVEF) was 25%. Enzyme-linked immunosorbent assay (ELISA) was positive for hydatid. Left posterolateral thoracotomy revealed dead hydatid cyst in upper lobe of the lung that was removed. Infected mother hydatid cyst was encountered inside pericardial sac. Scores of daughter hydatid cysts, varying in size from 1 to 30 mm, were scooped out intact from the pericardial cavity. There was significant improvement in cardiac activity, once the tamponade effect of hydatid cyst was removed. Pericardium was about 1 cm thick with lot of purulent and necrotic slough. To prevent future constrictive pericarditis, subtotal pericardiectomy was done. Intrapericardial hydatid cyst should be kept in mind whenever it obscures the heart border and patient has features of cardiac tamponade. Early surgical intervention may be required in these cases.

Video-assisted thoracoscopic surgery for the treatment of pericardial hydatid cyst

Introduction: We would like to present video-assisted thoracoscopic surgery for the treatment of pericardial hydatid cyst.Patient and Method: Thirty two-year-old female patient was referred for evaluation of a left mediastinal mass. Magnetic resonance image, computed tomography and transesophageal echocardiography confirmed a well circumscribed mass with compatible hydatid cyst at the left pericardial wall end of the differantial diagnosis. Our surgical plan entailed the endoscopic resection of pericardial hydatid cyst. We did not adopt a more precise strategy such as open procedure. We managed removal of the hydatid cyst by using video assisted thoracoscopic surgery.Results: The patient has been doing well for 4 years now after her surgery.Conclusion: We think that endoscopic approach is an effective treatment modality for pericardial hydatid cyst.

Acute common iliac arterial occlusion caused by ruptured primary cardiac hydrated cyst -A case report

Introduction

Hydatid cyst of the heart provides very rarely because of contractions of the heart natural resistance to the presence of viable cysts. Patients with cardiac hydatid cyst may remain asymptomatic for many years or have minor nonspecific complaints, but it is associated with an increased risk of lethal complications if left undiagnosed and untreated. Post rupture cardiac hydatid there is disseminated echinococcosis in the body.

Case presentation

We report a healthy 20-year old male, while he was working as a farmer who presented with sudden onset acute right lower limb ischemia caused by ruptured of primary hydatid cyst of the heart which managed as a surgical emergency.

Discussion

Patients with a cardiac hydatid cyst usually have symptoms after its rupture. Hydatid cyst rupture into left-sided chambers may cause systemic emboli, like in our case which presented with emboli of right common iliac artery and later on the patient had cerebral hydatid. Cardiac hydatid cyst can have two extremes, either remain asymptomatic over long periods or be discovered after serious and even fatal complications.

Conclusion

Acute limb ischemia should be considered as an extremely a rare cause of rupture cardiac hydatid in an endemic area of echinococcosis also, this case confirms the need for the evaluation of the patient well after ruptured cardiac hydatid for other sites of emboli like brain hydrated as in our patient.

[Cardiac compression of hydatid origin]

INTRODUCTION

Cardiac hydatid disease is uncommon and occurs in 0.5 to 2% of patients with hydatidosis. Isolated intrapericardial hydatid cystic disease is extremely rare.

OBSERVATION

We report the case of a young woman with cardiac compression due to multiple primary intrapericardial hydatid cysts. Since 1 year, she had gradual general health deterioration including dyspnoea, sweats and weight loss of 8kg. A widening of the mediastinum was observed on chest X-ray. The CT-scan, echocardiography and the dynamic IRM showed multiple mediastinal cysts with mass effect on the heart and main pulmonary artery. The size of the main pulmonary artery was reduced to 5 mm in diameter and the right upper pulmonary vein was nearly closed by posterior cysts. The right and left ventricular ejection fractions were estimated at about 34%. A complete resection of the cysts was performed by sternotomy. The surgical procedure was technically difficult because of major local inflammatory process. The postoperative outcome after an initial pulmonary embolism event was finally favourable.

CONCLUSION

Hydatidosis can lead to severe cardiac involvement. These rare forms of hydatid cystic disease must be known even in non endemic regions by surgeons because of increasing mobility of the world's population.

Current concepts of diagnosis and management of pericardial cysts

Pericardial cysts are rare with an incidence of about 1 in every 100,000 persons and one in 10 pericardial cysts may actually be a pericardial diverticulum. Pericardial cysts and diverticula share similar developmental origin and may appear as an incidental finding in chest roentgenogram in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of the surrounding anatomy. Cardiac MRI is recommended in the evaluation of the compressive effects caused by the pericardial cysts. The authors recommend echocardiography for serial follow up and image guided aspiration of the pericardial cyst in presence of compressive effects leading to cardiovascular and airway symptoms. A systematic approach is desirable for management of pericardial cysts depending on size, shape and compression effects, symptoms and easy access to serial Echocardiographic follow up. However, pericardial diverticulum may not be differentiated from cysts by the above testing, and only identified at surgery.

Hydatid Cyst of the Heart

Cystic hydatid disease is responsible for the loss of 1 to 3 million disability-adjusted life years every year. Infestation of the heart, though rare, can result in serious complications if left untreated. We retrospectively collected information on 19 patients with cardiac hydatid cyst admitted at the Center for Cardiac Surgery of Ibn Al-Bitar Hospital in Baghdad from July 2007 to July 2011 who were either in need of a cardiac surgery for treating hydatid cysts or presented with emergency conditions. Nine (47%) patients presented with left-sided heart failure and mitral valve dysfunction, 5 (26%) patients had hydatid cysts in the pericardium, 3 (16%) patients had hydatid cyst in the right ventricle and presented with right-sided heart failure, and 2 (11%) patients who presented with cardiac arrhythmias had infestation in the interventricular septum. Removal of cysts following open-heart surgery was successful and was followed by the use of mebendazole or albendazole for 5 years. We conclude that cardiac hydatid cyst that leads to various cardiac symptoms can be successfully managed and should be considered as a diagnostic possibility in patients with cardiac symptoms in endemic areas.

Invasive pericardial hydatid cyst: Excision of multiple huge cysts

Cardiac hydatid cyst is rare even in endemic countries, and poses a therapeutic challenge due to varying presentation and unpredictable pre-, peri-, and postoperative complications. We herein present a case of multiple, multifocal, huge pericardial hydatid cyst, with invasion into the left ventricle and main pulmonary artery in a young male patient, presented with atypical chest pain.

Right ventricular hydatid cyst ruptured to pericardium

Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

A Case of Isolated Cardiac Hydatid Cyst that Mimics Lymphoproliferative Malignancy

Cardiac cystic echinococcosis is a rare parasitic infestation caused by Echinococcus granulosus larvae and it composes 0.5-2% of all human cystic echinococcosis cases. The left ventricle is the most common affected area followed by right ventricle, interventricular septum, left atrium, right atrium, and interatrial septum. The diagnosis is difficult because of nonspecific clinical and radiographic findings. We present a case of isolated apical cardiac cystic echinococcosis mimicking lymphoproliferative disease.

Cardiac tamponade by hydatid pericardial cyst: a rare case report

Introduction

Hydatid cysts are most commonly found in the liver and lungs but they are rarely found in pericardium.

Case Presentation

We present a rare case of isolated hydatid cyst in pericardium of heart of a 70 year old female presented in casualty with unusual features like, dyspnea, palpitation and chest pain mimicking acute coronary syndrome.

Discussion

Hydatid cyst in Pericardium represents only 0.5-2% of cases of systemic echinoccocal infection. Isolated pericardial cyst is very rare in endemic region and may present mimicking acute coronary syndrome. Cardiac hydatid cysts should always be considered in presence of eosinophilia as present like acute coronary syndrome in endemic area.

Isolated Pericardial Hydatid Cyst: A Case Report

Cardiac echinococcosis is extremely rare, and cysts are found mostly within the myocardium. Most cardiac hydatid cysts are located in the left ventricular wall. Only a few cases of isolated pericardial hydatid cysts have been reported. Echocardiography, computed tomography and magnetic resonance imaging are important diagnostic tools for the diagnosis of echinococcosis. Herein, we report a rare case of isolated pericardial hydatid cyst who presented to our emergency department with complaints of mid-sternal chest pain and shortness of breath.