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Maasaoui K, Hamdaoui A, Akammar A, Bouardi NE, Haloua M, Lamrani MYA, Boubbou M, Maaroufi M, Alami B. Intramyocardial hydatid cyst revealed with ischemic stroke due to left ventricular systolic dysfunction: A case report. Radiol Case Rep 2024; 19:2841-2844. [PMID: 38689810 PMCID: PMC11059290 DOI: 10.1016/j.radcr.2024.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
Cardiac echinococcosis, although rare, presents a range of clinical manifestations depending on the cyst's location within the heart. These manifestations can range from asymptomatic conditions to serious complications such as arrhythmias, valvular dysfunction, cardiac tamponade, heart failure, shock, or even death. This case report describes the unusual presentation of a young man with an intramyocardial hydatid cyst, which was incidentally discovered following an ischemic stroke. Diagnostic evaluation included echocardiography, as well as chest and abdominal angiography via computed tomography (angio-CT). Surgical intervention was undertaken, involving cystectomy and the removal of the cyst contents. The patient's postoperative recovery was uneventful and favorable. This report emphasizes important diagnostic and management considerations specific to cardiac hydatid cysts and includes a review of the relevant literature to provide context and depth to our findings.
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Affiliation(s)
- Kaoutar Maasaoui
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Amina Hamdaoui
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Amal Akammar
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Nizar El Bouardi
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meryem Haloua
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Moulay Youssef Alaoui Lamrani
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Meryem Boubbou
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mustapha Maaroufi
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of radiology and interventional imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
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Banisefid E, Baghernezhad K, Beheshti R, Hamzehzadeh S, Nemati S, Samadifar Z, Owaysee Osquee H, Javanshir E, Naseri A. Cardiac hydatid disease; a systematic review. BMC Infect Dis 2023; 23:600. [PMID: 37705012 PMCID: PMC10500901 DOI: 10.1186/s12879-023-08576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Human cystic echinococcosis (CE), is a common health problem in low- and middle-income countries. Cardiac involvement is a relatively rare manifestation of Echinococcus infection. This study aims to summarize the evidence regarding the features of cardiac CE. METHODS Case series of the patients with cardiac CE, were included in this study. Non-English papers, case reports, reviews, letters, , commentaries, and conference abstracts were not included. A systematic search was conducted in PubMed and EMBASE databases and the risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. RESULTS Out of 3985 results of the searches, finally 37 studies were included in this systematic review. Based on available evidence, cardiac involvement is an uncommon but serious presentation of CE which presents with some non-specific signs and symptoms. Dyspnea, chest pain, and palpitation are the most common symptoms of the disease and normal sinus rhythm is the most common Electrocardiogram (ECG) feature. The disease is not associated with high mortality in case of timely diagnosis and appropriate management. DISCUSSION Consecutive and complete inclusion of participants, statistical analysis, and appropriate reporting of the demographics were the sources of bias in the included studies. The exclusion of non-English papers was a limitation during the review process. FUNDING The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380). REGISTRATION This study was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42022381204).
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Affiliation(s)
- Erfan Banisefid
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kosar Baghernezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rasa Beheshti
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hamzehzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheil Nemati
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azerbaijan, 5166/15731, Iran
| | - Zahra Samadifar
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azerbaijan, 5166/15731, Iran
| | - Hamid Owaysee Osquee
- Department of Infectious Disease, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Golgasht Street, Tabriz, East Azerbaijan, 5166/15731, Iran.
| | - Amirreza Naseri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran.
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3
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Dind A, Harmer JA, Hansen PS, Harris B. Extensive pulmonary artery embolisation caused by cardiac hydatid cyst rupture. BMJ Case Rep 2021; 14:14/4/e240521. [PMID: 33827876 PMCID: PMC8030676 DOI: 10.1136/bcr-2020-240521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case study is a rare example of cardiac hydatidosis in a high-income country, where a middle-aged man presented with a ruptured right ventricular cyst causing anaphylaxis, pulmonary emboli and dissemination of Echinococcus throughout the lung. He survived the cyst rupture and underwent cardiac surgery but had incomplete resection and experienced progressive cardiopulmonary hydatidosis despite antihelminthic therapy. As a result, he experienced an array of cardiopulmonary sequelae over his lifespan. This case report highlights rare clinical manifestations of hydatid disease and potential complications of its treatment.
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Affiliation(s)
- Ashleigh Dind
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jason A Harmer
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter S Hansen
- Department of Cardiology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Benjamin Harris
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Ben Khalfallah A, Ben Slima H. [Cardiac hydatid cyst. Which imaging modality for an accurate diagnosis?]. Ann Cardiol Angeiol (Paris) 2017; 66:102-108. [PMID: 28342525 DOI: 10.1016/j.ancard.2016.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/21/2016] [Indexed: 11/25/2022]
Abstract
Cardiac echinococcosis is rare. Its spontaneous course is serious because of the risk of rupture. Its clinical manifestations are variable, often latent and misleading. The diagnosis is sometimes referred to by chest radiography. It is much facilitated by non-invasive imaging techniques in particular transesophageal and transthoracic echocardiography, CT scan and magnetic resonance imaging. The latter through a morphological and topographical analysis accurate diagnosis of hydatid cyst and its relationship to cardiac muscle and surrounding tissue. Through functional analysis in cine cyst movements relative to the heart wall, it confirms its free or fixed character in the heart chambers, determines its insertion area, its deformability, the risk of rupture and its impact on myocardial contraction. Our case illustrates the relative contribution of these different imaging techniques and their respective contributions to the identification of hydatid cyst of its wall, its contents, its relationship with the various tunics and heart chambers and its relations with the lungs and mediastinum.
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Affiliation(s)
- A Ben Khalfallah
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de cardiologie, hôpital De Menzel Bourguiba, 7050 Bourguiba, Tunisie.
| | - H Ben Slima
- Faculté de médecine de Tunis, université de Tunis El Manar, 1007 Tunis, Tunisie; Service de cardiologie, hôpital De Menzel Bourguiba, 7050 Bourguiba, Tunisie
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Singh A, Sharma R, Garg A, Nanda NC, Elsayed M, Taher A, Bulur S. Usefulness of bubble study in echocardiographic diagnosis of contained rupture of hydatid cyst in the right ventricular outflow tract. Echocardiography 2016; 33:1402-8. [PMID: 27650224 DOI: 10.1111/echo.13317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac-like structure in the right ventricular outflow tract (RVOT) containing a heterogenous echogenic mass. This sac-like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst. Bubble echoes were noted within the sac-like structure but did not penetrate the inner wall of the cyst which contained echogenic material, indicating that the rupture was confined only to the outer layers. At surgery, a 0.5 cm communication was noted between the cyst and the RVOT and pathology confirmed the diagnosis of hydatid cyst.
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Affiliation(s)
- Amitoj Singh
- Department of Cardiology, St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Ravindra Sharma
- Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India
| | - Ashok Garg
- Jaipur Heart Institute, Jaipur, Rajasthan, India
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Mahmoud Elsayed
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ahmed Taher
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Serkan Bulur
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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Ward TJ, Jacobi AH, Mendelson DS, Lento PA. AIRP Best Cases in Radiologic-Pathologic Correlation: CardiacEchinococcusInfection. Radiographics 2013; 33:1413-8. [DOI: 10.1148/rg.335125209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Hydatid disease is endemic to various regions of the world, with an incidence of 0.4 per 100,000 persons. Isolated cardiac involvement is rare and occurs in only 0.02%-2% of cases. As the majority of cases are asymptomatic, can present catastrophically, and lead to high mortality, it has become increasingly important to identify the disease in an early stage and treat it with surgical excision. This review aims to familiarize the readers with the varied presentations, early diagnosis, and management of cardiac hydatid disease.
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Affiliation(s)
- Vijayakumar Abhishek
- Department of General Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, India.
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Elkarimi S, Ouldelgadia N, Gacem H, Zouizra Z, Boumzebra D, Blelaabidia B, Elhattaoui M. [Tamponade reveals an intra-pericardial hydatid cyst - a case report]. Ann Cardiol Angeiol (Paris) 2012; 63:267-70. [PMID: 22436634 DOI: 10.1016/j.ancard.2012.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 01/26/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hydatid disease is a parasitic infection caused by the development of the larval form of the Teania of Echinococcus granulosus. It is endemic in many regions of the world such as the Mediterranean basin. Location without pericardial cardiac involvement is extremely rare. In this case study, we will elaborate the case of an intra-pericardial hydatidosis disease without cardiac location revealed by a tamponade. OBSERVATION AA is a 60-year-old man with no pathological history and who was admitted for a tamponade assessment. Indeed, the cardiovascular examination showed a muffling of the heart sound and signs of a right heart failure. Besides, the ECG shows a microvoltage, and the chest radiography shows cardiomegaly. Moreover, the transthoracic echocardiogram confirmed the presence of an abundant pericardial effusion along with signs of a tamponade. It also reifies the presence of, at the intra-pericardial level, a multiple vesicular formation giving a cluster of grapes highly suggestive of an intra-pericardial hydatid disease. An emergency surgical drainage allowed removing about two liters of suspicious fluid along with cysts and white membranous. The pathological examination of the membranous confirmed the diagnosis of a pericardial hydatid cyst. The performance of a chest CT and an abdominal ultrasound's scan to identify other locations shows no further anomalies. The patient was put under medical treatment (Albendazole(®)) and is showing a good clinical improvement. CONCLUSION The intra-pericardial hydatid disease is another cause of tamponade not to fail despite its rareness, as it is endemic to North African countries.
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Affiliation(s)
- S Elkarimi
- Service de cardiologie, FMPM, PCIM, CHU Mohammed VI, Marrakech, Maroc.
| | - N Ouldelgadia
- Service de chirurgie cardiovasculaire, CHU Mohammed VI, Marrakech, Maroc
| | - H Gacem
- Service de cardiologie, FMPM, PCIM, CHU Mohammed VI, Marrakech, Maroc
| | - Z Zouizra
- Service de chirurgie cardiovasculaire, CHU Mohammed VI, Marrakech, Maroc
| | - D Boumzebra
- Service de chirurgie cardiovasculaire, CHU Mohammed VI, Marrakech, Maroc
| | - B Blelaabidia
- Service d'anatomie pathologique, CHU Mohammed VI, Marrakech, Maroc
| | - M Elhattaoui
- Service de cardiologie, FMPM, PCIM, CHU Mohammed VI, Marrakech, Maroc
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Díaz-Menéndez M, Pérez-Molina JA, Norman FF, Pérez-Ayala A, Monge-Maillo B, Fuertes PZ, López-Vélez R. Management and outcome of cardiac and endovascular cystic echinococcosis. PLoS Negl Trop Dis 2012; 6:e1437. [PMID: 22235354 PMCID: PMC3250507 DOI: 10.1371/journal.pntd.0001437] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 10/30/2011] [Indexed: 12/29/2022] Open
Abstract
Background Cystic echinococcosis (CE) can affect the heart and the vena cava but few cases are reported. Methods A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995–2009) is reported. Results Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4–93 months). One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE) and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications. Conclusions Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas. Cardiac and vascular involvement are infrequent in classical cystic echinococcosis (CE), but when they occur they tend to present earlier and are associated with complications that may be life threatening. Cardiovascular CE usually requires complex surgery, so in low-income countries the outcome is frequently fatal. This case series describes the characteristics of cardiovascular CE in patients diagnosed and treated at a Tropical Medicine & Clinical Parasitology Center in Spain. A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995–2009) is reported. The main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. The clinical picture and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas. CE is a neglected disease and further studies are necessary in order to make more definite management recommendations for this rare and severe form of the disease. The authors propose a general approach based on cyst location: exclusively cardiac, endovascular or both.
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Affiliation(s)
- Marta Díaz-Menéndez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - José Antonio Pérez-Molina
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francesca Florence Norman
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Ana Pérez-Ayala
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Begoña Monge-Maillo
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Pilar Zamarrón Fuertes
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Rogelio López-Vélez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- * E-mail:
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Multidetector CT and MR imaging cardiac hydatidosis: case report and review of the literature. Int J Cardiovasc Imaging 2011; 27 Suppl 1:97-102. [PMID: 22012491 DOI: 10.1007/s10554-011-9958-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 10/04/2011] [Indexed: 10/16/2022]
Abstract
Cardiac hydatid cysts are uncommon but potentially fatal. We present a case of isolated unilocular and multivesicular hydatid cysts in the heart, and provide a literature review of this rare condition. A 35-year-old man presented to our cardiology unit with acute chest pain. Computed tomography showed two cystic lesions in the heart. One unilocular cyst was located close to the left atrium and compressed the pulmonary artery. The other multivesicular cyst adhered to the left ventricle and displaced the left coronary arteries. T2-weighted magnetic resonance images revealed lesions in the pericardial cavity with bright signal intensity. Dot immunogold filtration assay was performed, and positive results for anti-EgCF antibody, anti-EgP antibody and anti-EgB antibody for cystic hydatidosis were found. Cardiac hydatidosis was diagnosed because of typical imaging findings and positive serology. The patient underwent surgical excision of the cysts. Postoperatively, symptoms of the patient resolved.
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12
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Cece H, Yildiz S, Sogut O, Hazar A, Sezen Y. Isolated Pericardial Hydatid Cyst: A Case Report. Cardiol Res 2011; 2:253-255. [PMID: 28357016 PMCID: PMC5358288 DOI: 10.4021/cr96w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2011] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Hasan Cece
- Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa, Turkey
| | - Sema Yildiz
- Harran University, Faculty of Medicine, Department of Radiology, Sanliurfa, Turkey
| | - Ozgur Sogut
- Harran University, Faculty of Medicine, Department of Emergency Medicine, Sanliurfa, Turkey
| | - Abdussamet Hazar
- Harran University, Faculty of Medicine, Department of Cardiovascular Surgery, Sanliurfa, Turkey
| | - Yusuf Sezen
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, Turkey
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Ellouze S, Bahri M, Abdennadher M, Kossentini M, Abid N, Chaabouni S, Khabir A, Boudawara T. [Rare cause of pulmonary embolism in a child]. Arch Pediatr 2011; 18:987-9. [PMID: 21803553 DOI: 10.1016/j.arcped.2011.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 03/01/2011] [Accepted: 06/14/2011] [Indexed: 11/27/2022]
Abstract
Cardiac hydaticyst is a rare condition and accounts for only 0.5 to 2% of all visceral locations of hydatid disease. The objective of this study was to point out the main clinical, radiological, and disease-course characteristics of this rare and serious pathology. We report a 13-year-old patient with a hydatid pulmonary embolism caused by a hydatid cyst of the interauricular septum. The diagnosis was established by transthoracic echocardiography, thoracic CT scan, and hydatid serology. Surgery was performed without delay and the outcome was good after 15 months of follow-up. This case underlines the need for rapid diagnosis and surgery before complications of cardiac hydatid cyst.
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Affiliation(s)
- S Ellouze
- Laboratoire d'anatomie et de cytologie pathologiques, CHU Habib-Bourguiba, route El-Ain, 3029 Sfax, Tunisie.
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14
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Gruttadauria S, D'Ancona G, Pagano D, Panarello G, Follis F, Gridelli B. Complex Hydatid Cyst of the Liver with Intra-Cardiac Involvement. Am Surg 2010. [DOI: 10.1177/000313481007601210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Salvatore Gruttadauria
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy and Department of Surgery University of Pittsburgh Pittsburgh, Pennsylvania
| | - Giuseppe D'Ancona
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy
| | - Duilio Pagano
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy
| | - Giovanna Panarello
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy
| | | | - Bruno Gridelli
- Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione Palermo, Italy and Department of Surgery University of Pittsburgh Pittsburgh, Pennsylvania
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Tasdemir K, Akcali Y, Gunebakmaz O, Kaya MG, Mavili E, Sarli B, Tasdemir A, Ceyran H. Surgical approach to the management of cardiovascular echinococcosis. J Card Surg 2009; 24:281-4. [PMID: 19438781 DOI: 10.1111/j.1540-8191.2008.00727.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Echinococcosis is a serious health problem in some regions of the world. Although cardiovascular hydatid cyst is rare, its early diagnosis and surgical management is important. METHODS We reviewed 10 patients with cardiovascular hydatid cyst who underwent surgery in our department between January 1982 and 2007. Standard cardiopulmonary bypass and antegrade cardioplegia with aortic cross-clamping were used in all but one patient. After the cysts were removed, the cavity was cleaned and then obliterated with purse-string sutures. Albendazole was used in all patients. The mean follow-up was 4.5 years. RESULTS The mean age was 27 years (range 12 to 76 years). Eight patients were men. The hydatid cysts were located on left ventricle (five patients), left atrium (two patients), right ventricle (three patients), right atrium (one patient), pericardium (one patient), and aorta (one patient). Except for two patients who died, all were discharged without postoperative complications. There was no late cardiac mortality or recurrence. CONCLUSIONS Cardiac hydatid cyst should be treated surgically without delay. Although its surgical treatment carries a high complication rate, gentle handling of the heart during cardiopulmonary bypass minimizes operative risk.
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Affiliation(s)
- Kutay Tasdemir
- Department of Cardiovascular Surgery, Erciyes University School of Medicine, Kayseri, Turkey
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Soleimani A, Sahebjam M, Marzban M, Shirani S, Abbasi A. Hydatid Cyst of the Right Ventricle in Early Pregnancy. Echocardiography 2008; 25:778-80. [DOI: 10.1111/j.1540-8175.2008.00668.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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17
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Ozturk E, Ozturk A, Zeyrek F, Demirbag R, Temamogullari AV. Recurrent Pulmonary Microemboli Secondary to Primary Cardiac Hydatidosis. Heart Lung Circ 2007; 16:457-9. [PMID: 17314071 DOI: 10.1016/j.hlc.2006.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2004] [Revised: 09/28/2006] [Accepted: 10/01/2006] [Indexed: 11/20/2022]
Abstract
Primary cardiac hydatid cysts are rarely diagnosed and seldom rupture to lungs via pulmonary vein resulting in multifocal cystic lesions. We report a rare instance of an interventricular hydatid cyst. A 19-year-old patient was admitted with dyspnea and multiple homogenous opacities with different sizes in his chest X-ray and contrast enhanced thorax computed tomography. We considered recurrent pulmonary microemboli, although neither systemic embolisation nor intravascular cyst of pulmonary arteries was detected. Due to extensive distribution of the pulmonary cysts, only the cardiac cyst was taken surgically. The patient remains in our care without any pulmonary improvement despite appropriate medical treatment.
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Affiliation(s)
- Ebru Ozturk
- Ozel Dünya Hastanesi Radyoloji Bolumu, Sanliurfa, Turkey
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18
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Tufekcioglu O, Birincioglu CL, Arda K, Fansa I, Saritas A, Karahan M. Echocardiography Findings in 16 Cases of Cardiac Echinococcosis: Proposal for a New Classification System. J Am Soc Echocardiogr 2007; 20:895-904. [PMID: 17617317 DOI: 10.1016/j.echo.2006.12.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Echocardiography is a reliable method for diagnosing cardiac echinococcosis (CE). Currently, there is no echocardiographic classification system for CE, but such a scheme would facilitate diagnosis. This article presents echocardiographic data for 16 cases with CE and outlines a method for echocardiographic classification of CE based on the World Health Organization's ultrasonographic classification of cystic echinococcosis. METHODS We assessed the echocardiographic features of hydatid cysts in 16 patients with CE (9 women and 7 men; mean age, 41 +/- 18.3 years), all of whom underwent cardiac surgery. The proposed classification system identifies 3 types of CE lesions: active (unilocular or multilocular and echolucent, showing double-layered cyst wall and hydatid sand); transitional (shrunken as a result of reduced intracystic pressure, and showing water lily sign); and inactive (completely degenerated contents creating the ball-of-wool sign). Preoperative echocardiographic findings (lesion location, imaging appearance [unilocular/multilocular, solid/semisolid], echocardiographic classification/type, number of lesions) were compared with computed tomographic, intraoperative echocardiographic, surgical, and parasitological findings. RESULTS Preoperative echocardiography revealed 18 hydatid cysts (10 myocardial, 7 pericardial, 1 on the ascending aorta). In all, 10 lesions appeared multilocular, 6 unilocular, and 2 solid. A total of 11 were active, 5 transitional, and 2 inactive. Computed tomography identified 20 lesions total, therefore, two were missed on echocardiography. The preoperative echocardiographic findings correlated well with intraoperative echocardiographic, surgical, and parasitological findings. CONCLUSION The 3 types of CE lesions defined in this proposed classification system feature distinct echocardiographic characteristics. This new system is reliable and practical, and could assist with diagnosis and rapid treatment of CE.
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Affiliation(s)
- Omac Tufekcioglu
- Department of Cardiology, Cardiovascular Surgery, Yuksek Ihtisas Hospital, Ankara, Turkey.
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19
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Barbetseas J, Lambrou S, Aggeli C, Vyssoulis G, Frogoudaki A, Tsiamis E, Stefanadis C. Cardiac hydatid cysts: echocardiographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:201-205. [PMID: 15856512 DOI: 10.1002/jcu.20108] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Cardiac hydatid disease is rare. Many patients are asymptomatic, hence cardiac involvement is often discovered incidentally. Diagnosis is also difficult because of a long period between parasitic infection and the manifestation of disease. Rupture of a cardiac cyst is a serious complication. Diagnosis of cardiac hydatid cysts is often made using transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) provides details of the cysts. We present the cases of 3 patients with nonspecific symptoms of their endemic parasitic disease. The results of sonographic examinations in all patients strongly suggested the presence of cardiac hydatid cysts. One patient had a cyst in the external surface of the left ventricular apical-lateral wall visualized with TTE and TEE. Parasitic serology was negative. She underwent surgery, which confirmed a cyst located in the pericardium, and then was treated with albendazole. Another patient had a cyst in the left ventricle demonstrated by TTE and TEE and confirmed with serology. Color Doppler sonography verified that her cardiac cyst was in communication with the left ventricle. She was not a surgical candidate and was treated with albendazole. The final patient had a septated cyst in the media basilar portion of the interventricular septum demonstrated using TTE, and CT. He refused surgical treatment and albendazole was prescribed. Chest radiographs in 3 patients failed to show the cysts, and serology in 1 patient failed to indicate a hydatid cyst. Follow-up at 1-2 years revealed no recurrence in any patient. In all 3 cases, cysts could be visualized from the subcostal view via echocardiography. Imaging is critical for the early diagnosis, assessment, and follow-up of patients with this disease.
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Affiliation(s)
- John Barbetseas
- 1st Department of Cardiology of the University of Athens, Hippokration Hospital, Greece
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20
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Erentuğ V, Bozbuğa N, Kirali K, Mataraci I, Kaymaz C, Balkanay M, Akinci E, Ipek G, Yakut C. Cardiac hydatid cysts: surgical treatment and results. J Card Surg 2004; 19:358-60. [PMID: 15245471 DOI: 10.1111/j.0886-0440.2004.4094_11.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
From 1991 to 2000 six patients with intracardiac echinococcosis underwent surgical treatment. Four patients were females and two were males, age of the patients ranged from 20 to 68 years. Two patients had symptoms, all patients were diagnosed as a component of multi-organ echinococcosis and three of them underwent operation before. They were examined serologically and echocardiographically. Cardiac hydatidosis were diagnosed in right ventricle (in three cases), left ventricle (in one case), and interventricular septum (in two cases). Sternotomy was the approach used and all patients were operated on using cardiopulmonary bypass. Intraoperative rupture did not occur. There was no operative mortality, the only morbidity was complete atrioventricular block necessitating VVD pacemaker implantation in the patient with hydatid cyst involving the basal interventricular septum. All patients were followed by medical treatment with albendazole (400 mg/day) and no recurrences were reported in the late follow-up.
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Affiliation(s)
- Vedat Erentuğ
- Department of Cardiovascular Surgery Koşuyolu Heart and Research Hospital, Istanbul, Turkey
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21
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Savas L, Onlen Y, Akcali C, Aslan B, Pourbagher A, Tunc T, Ozkoc G. Hydatid disease with atypical localization: 4 cases report. ACTA ACUST UNITED AC 2004; 36:613-5. [PMID: 15370676 DOI: 10.1080/00365540410017581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hydatid disease caused by Echinococcus often manifests as slowly growing cystic mass and mainly affects the liver or lung and rarely other parts of the body such as brain, heart, bone and muscle. Cyst may be single or multiple, uni-or multiloculated. In this paper 4 hydatic cases, multiple and atypically localized are presented. Of the 4 cases, 2 were known to suffer from hydatid disease, having had a hepatic cyst removal previously. Thus, when faced with a hydatid cyst in any part of the body, it is preferable to examine other parts of the body by radiological imaging methods.
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Affiliation(s)
- Lutfu Savas
- Department of Infection, Disease and Microbiology, School of Medicine, Mustafa Kemal University, Antakya, Turkey.
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22
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Abstract
Echinococcosis is a frequent parasitic human infection in sheep-farming areas. It is caused by the larval or the cyst stage of a tapeworm, mainly Echinococcus granulosis. Humans can be infected by ingesting tapeworm eggs, from which cysts will be developed mostly in the liver and the lung. Cardiac involvement of echinococcosis is rare and its clinical evolution is silent till the complication stage. A young adult died suddenly. The autopsy showed a ruptured hydatid cyst hollowed on the right side of the interventricular septum, protruding in the ventricle. The left pulmonary artery contained white-colored fragments of a membrane, similar to the one found in the right ventricle, associated to small vesicles. All these elements were obstructing this vessel, extending to small pulmonary arterial branches. Dissection of the other organs did not show other locations. Microscopic examinations ascertained the diagnosis of echinococcosis. Death was imputed to a right ventricular hydatid cyst rupture with pulmonary artery embolism.
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Affiliation(s)
- A Chadly
- Department of Forensic Medicine, University Hospital Fattouma Bourguiba, Monastir, Tunisia.
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23
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Ben-Hamda K, Maatouk F, Ben-Farhat M, Betbout F, Gamra H, Addad F, Fatima A, Abdellaoui M, Dridi Z, Hendiri T. Eighteen-year experience with echinococcosus of the heart: clinical and echocardiographic features in 14 patients. Int J Cardiol 2004; 91:145-51. [PMID: 14559124 DOI: 10.1016/s0167-5273(03)00032-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We present a retrospective analysis of clinical symptoms and echocardiographic features in 14 patients having cardiac hydatic cysts and screened during the 18 last years, with surgical correlations in 13. The heart was the sole location of the cyst in six patients. The revealing symptoms were precordial pain (six patients), dyspnea (two patients). A systolic murmur of false pulmonic stenosis was present in three patients. In 13 patients, two-dimensional echocardiographic images of hydatic cysts were those of masses of liquid content with a well-contrasted capsule, which was single in eight patients and multiple in five, one of which had a honeycomb appearance. The mass was solid and calcified in one patient. The outlines of the cysts were particularly sharp on transesophageal echocardiograms (six patients). The cyst size ranged from 1.8 to 11 cm in diameter. Cysts were located in the intramyocardium in 10 patients (left ventricle in four patients, interventricular septum in four patients, right ventricle in two patients), the pericardium in three and the mediatinum in one. There were a Doppler pulmonary valve gradient in three patients. Computed tomography (eight patients) and coronary arteriography (seven patients) have no additional diagnosis value than echocardiography. Nuclear magnetic resonance imaging (three patients) was helpful in determining extracardiac extension of the cysts. Transthoracic and transesophageal two-dimensional echocardiography have a central role in diagnosing cardiac hydatic cysts.
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Affiliation(s)
- Khaldoun Ben-Hamda
- Department of Medicine, Division of Cardiology, Fattouma Bourguiba University Hospital, Farhat Hached Avenue, 5000 Monastir, Tunisia.
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24
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Mahdhaoui A, Bouraoui H, Souissi J, Mabrouk KH, Bahri F, Amara H, Ernez-Hajri S, Jeridi G, Ammar H. [Double location of cardiac hydatid cyst: left ventricle and pulmonary artery]. Rev Med Interne 2004; 25:94-6. [PMID: 14736568 DOI: 10.1016/j.revmed.2003.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Atilgan D, Kudat H, Tükek T, Ozcan M, Yildirim OB, Elmaci TT, Onursal E. Role of transesophageal echocardiography in diagnosis and management of cardiac hydatid cyst: report of three cases and review of the literature. J Am Soc Echocardiogr 2002; 15:271-4. [PMID: 11875393 DOI: 10.1067/mje.2002.120507] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although diagnostic value of transthoracic echocardiography in cardiac echinococcus is well established, the role of transesophageal echocardiography in both the diagnosis and the management of this entity is not well known. We present 3 unusual cases of cardiac hydatid cyst in which transesophageal echocardiography was used. A review of the literature on the subject is also presented.
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Affiliation(s)
- Dursun Atilgan
- Departments of Cardiology, Istanbul Medical Faculty, Istanbul, Turkey
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27
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Charet E, Roudaut R, Lafitte S, Laffort P, Madonna F, de Mascarel A. Echocardiographic demonstration of rupture of intraseptal hydatid cyst. J Am Soc Echocardiogr 2000; 13:955-8. [PMID: 11029723 DOI: 10.1067/mje.2000.106824] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of an intracardiac hydatid cyst observed before and after rupture complicated by a pulmonary embolus. The echocardiographic findings are analyzed and discussed. This dramatic course underscores the surgical emergency of cardiac hydatidosis.
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Affiliation(s)
- E Charet
- Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, France
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28
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Moutiris JA, Mavrommatis P, Zambartas C, Henein M. Isolated cardiac echinococcosis in Cyprus. Int J Cardiol 2000; 75:99-101. [PMID: 11203329 DOI: 10.1016/s0167-5273(00)00265-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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29
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Pedrosa I, Saíz A, Arrazola J, Ferreirós J, Pedrosa CS. Hydatid disease: radiologic and pathologic features and complications. Radiographics 2000; 20:795-817. [PMID: 10835129 DOI: 10.1148/radiographics.20.3.g00ma06795] [Citation(s) in RCA: 436] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hydatid disease primarily affects the liver and typically demonstrates characteristic imaging findings. However, there are many potential local complications (eg, intrahepatic complications, exophytic growth, transdiaphragmatic thoracic involvement, perforation into hollow viscera, peritoneal seeding, biliary communication, portal vein involvement, abdominal wall invasion). Furthermore, secondary involvement due to hematogenous dissemination may be seen in almost any anatomic location (eg, lung, kidney, spleen, bone, brain). Ultrasonography (US) is particularly useful for the detection of cystic membranes, septa, and hydatid sand. Computed tomography (CT) best demonstrates cyst wall calcification and cyst infection. CT and magnetic resonance (MR) imaging may demonstrate cyst wall defects as well as the passage of contents through a defect. Chest radiography, US, CT, and MR imaging are all useful in depicting transdiaphragmatic migration of hydatid disease. CT is the modality of choice in peritoneal seeding. US and CT demonstrate rupture in most cases that involve wide communication. Indirect signs of biliary communication include increased echogenicity at US and fluid levels and signal intensity changes at MR imaging. CT allows precise assessment of osseous lesions, whereas MR imaging is superior in demonstrating neural involvement. Familiarity with atypical manifestations of hydatid disease may be helpful in making a prompt, accurate diagnosis.
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Affiliation(s)
- I Pedrosa
- Department of Diagnostic Imaging, Hospital Clínico San Carlos, Universidad Complutense, C/ Martín Lagos s/n, 28040 Madrid, Spain.
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Nadareishivili A, Goziridze M, Zodelava E, Nachkepia M, Grigolia G, Chekanov V. Unusual recurrence of hydatid cysts of the heart: report of two cases and review of the clinical and surgical aspects of the disease. J Card Surg 2000; 15:223-8. [PMID: 11414609 DOI: 10.1111/j.1540-8191.2000.tb00460.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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