Cardiac hydatid disease: CT and MRI findings. AJR Am J Roentgenol. 2008;190:226-232. [PMID: 18094316 DOI: 10.2214/ajr.07.2035]

Intramyocardial hydatid cyst revealed with ischemic stroke due to left ventricular systolic dysfunction: A case report

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.

Epicardial Space: Comprehensive Anatomy and Spectrum of Disease

The epicardial space (ES) is the anatomic region located between the myocardium and the pericardium. This space includes the visceral pericardium and the epicardial fat that contains the epicardial coronary arteries, cardiac veins, lymphatic channels, and nerves. The epicardial fat represents the main component of the ES. This fat deposit has been a focus of research in recent years owing to its properties and relationship with coronary gossypiboma plaque and atrial fibrillation. Although this region is sometimes forgotten, a broad spectrum of lesions can be found in the ES and can be divided into neoplastic and nonneoplastic categories. Epicardial neoplastic lesions include lipoma, paraganglioma, metastases, angiosarcoma, and lymphoma. Epicardial nonneoplastic lesions encompass inflammatory infiltrative disorders, such as immunoglobulin G4-related disease and Erdheim-Chester disease, along with hydatidosis, abscesses, coronary abnormalities, pseudoaneurysms, hematoma, lipomatosis, and gossypiboma. Initial imaging of epicardial lesions may be performed with echocardiography, but CT and cardiac MRI are the best imaging modalities to help characterize epicardial lesions. Due to the nonspecific onset of signs and symptoms, the clinical history of a patient can play a crucial role in the diagnosis. A history of malignancy, multisystem diseases, prior trauma, myocardial infarction, or cardiac surgery can help narrow the differential diagnosis. The diagnostic approach to epicardial lesions should be made on the basis of the specific location, characteristic imaging features, and clinical background. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Extensive myocardial calcifications in a dialysis patient: A porcelain heart manifesting with abdominal pain

This case report describes a 41-year-old male patient with chronic kidney disease on peritoneal dialysis presenting with upper abdominal pain and mild thigh numbness. CT chest demonstrated extensive myocardial calcifications and left atrial thrombus. This case emphasizes the clinical relevance of myocardial calcifications, especially in patients with end-stage renal disease. It also highlights the potential association between these calcifications and complications such as atrial fibrillation and thromboembolic events. The findings emphasize the need for diagnostic vigilance and an improved understanding of the pathophysiology of myocardial calcifications in the context of renal disease.

Large right ventricular hydatid cyst in a child: a case report

BACKGROUND

Cystic Hydatid disease is a parasitic infection with a worldwide distribution. It is caused by the larval stages of a species of tapeworms known as Echinococcus granulosus. Even in endemic areas; Cardiac involvement by hydatidiosis is very rare and has atypical presentations as well as localization which make it undiagnosed in about 10% of cases. The left ventricle is the most Common chamber involved by the hydatid cyst and isolated involvement of the right ventricle is very rare, especially in children. The aim of the present study was to describe hydatid cardiac cyst of the right ventricle of a child.

CASE PRESENTATION

We present a rare case of an 8 year-old boy, living in a rural area, who was diagnosed with a cardiac hydatid cyst in the right ventricle. He also had multiple pulmonary hydatid cysts and presented with dyspnea, cough and atypical chest pain. The patient underwent surgery for the resection of pulmonary cysts and, subsequently, cardiac hydatid cyst. The outcome was favorable seven weeks after surgery and there was no clinical and echocardiographic recurrence.

CONCLUSION

Cardiac Echinococcosis must be suspected in endemic areas, diagnosed with appropriate imaging techniques, and treated appropriately.

Cardiac Hydatid Cyst: An Uncommon Cause of Complete Atrioventricular Block

Hydatidosis is a zoonosis caused by Echinococcus granulosus, leading to the formation of cysts on involved organs. Cardiac involvement is rare and can cause a wide range of complications secondary to rupture, embolization, or compression. Its diagnosis is challenging, and is generally confirmed through data related to clinical manifestations, environmental exposure, and laboratory and imaging exams. Surgical removal is necessary in most cases, in which an association with antiparasite therapy is recommended. The present article describes a case of a cardiac hydatid cyst associated with a complete atrioventricular block (AVB) in a young adult patient, with the need for a pacemaker implant, an atypical presentation, and scarce reports in the literature.

Precordial pain induced by the isolated cardiac hydatid cyst in interventricular septum: a case report

BACKGROUND

Human hydatid disease occurs after infection with Echinococcus granulosus, mainly involves liver and lung, while hydatid involves heart is infrequent. A great majority of hydatid diseases could be asymptomatic, and incidentally found through examination. Here, we reported a woman who suffered an isolated cardiac hydatid cyst located at the interventricular septum.

CASE PRESENTATION

A 48-year-old woman presented intermittent chest pain was admitted to the hospital. Imaging examination revealed a cyst located at the interventricular septum near the right ventricular apex. Considering medical history, radiological findings and serological results, cardiac hydatid disease was suspected. The cyst was successfully removed, while pathological biopsy confirmed the diagnosis of infection of Echinococcus granulosus. Postoperative course was uneventful, the patient was discharged from hospital without complications.

CONCLUSION

For symptomatic cardiac hydatid cyst, surgical resection is necessary to avoid progression of disease. During surgical procedure, appropriate methods to reduce the potential risk of hydatid cyst metastasis are essential. Besides surgery, combined with regular drug therapy is an effective strategy to prevent reappearance.

Hydatid Disease: A Pictorial Review of Uncommon Locations

Hydatid disease is a zoonotic infection caused primarily by the tapeworm parasite, Echinococcus granulosus. It is considered an endemic disease in the Mediterranean region.  In about 90% of cases, hydatid cysts are found in the liver and lungs; however, any other organ in the body may be affected, particularly in endemic areas. When encountering cystic lesions in these areas, the physician should always keep hydatid disease as a possible diagnosis in mind. To avoid life-threatening conditions such as anaphylactic shock or pressure effect on vital organs, timely diagnosis, and proper management are critical. When a rare site is involved, hydatid disease should be diagnosed using a combination of serologic assays and imaging modalities such as ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). These imaging modalities can also be used to determine the extent of the disease and assess possible complications. Here, we present a pictorial review of typical imaging manifestations of hydatid cysts in unusual sites. Being aware of these imaging features will assist physicians in making an accurate, timely diagnosis and subsequently, providing optimal management.

Concomitant intramyocardial and hepatic hydatid cysts diagnosed by multi-modality imaging: A rare case report

Cardiac echinococcosis is a potentially fatal form of hydatid disease; yet, its diagnosis and treatment are challenging due to the variability in its clinical manifestations and due to its various unpredictable preoperative complications. Multi-modality imaging is shown to provide important guidance for the treatment and decision-making. We report a rare case of a 50-year-old woman who had concomitant cardiac and hepatic hydatid cysts. She presented with abdominal pain and elevated eosinophilic white blood cells. The initial abdominal ultrasound and computerized tomography revealed a large cyst in the liver. An intramyocardial cyst was detected by two-dimensional echocardiography. Three-dimensional echocardiography increased the confidence level of two-dimensional echocardiography by displaying the three-dimensional volume of the cyst and allowing visualization of its spatial characteristics and the relationships with adjacent cardiac structures, which was subsequently confirmed at surgery. Multi-detector computed tomography and magnetic resonance imaging helped localize and define the typical morphological features of the cyst. Serology and antigen detection were used for diagnosis. This rare case underlines the integration of clinical, multi-modality imaging, and pathological data in the diagnosis of concomitant intramyocardial and hepatic hydatid cysts. Surgical resection of cysts and anthelmintic medication were successful in the management of this patient.

Case report: Right atrium-inferior vena cava bypass in a patient with unusual cardiac cystic echinococcosis

Cardiovascular hydatid disease is caused by parasitic infection of Echinococcus granulosus, which could be asymptomatic or life-threatening depending on lesion site, granuloma size, and disease progression. Diagnosis and treatment of cardiac echinococcosis should be under comprehensive consideration. In this case, we reported a successful right atrium-inferior vena cava bypass surgery in a 31-year-old female with unresectable right atrial echinococcosis and inferior vena cava obstruction.

Case Report: Sudden death related to unrecognized cardiac hydatid cyst

Echinococcosis, also known as hydatid disease, is a common parasitic human infestation found in sheep-breeding areas. It is caused by the larvae stage of Echinococcus granulosus, and cysts develop mostly in the lungs and the liver. Cardiac involvement is unusual and silent until acute complications or a fatal outcome occurs. Herein, we report an autopsy case of a young healthy adult who died suddenly. The autopsy revealed an external bulging on the right heart ventricle outlet with a fluid-filled cystic cavity discovered on sectioning. Dissection of other organs did not reveal other cyst locations. Histological examination ascertained the diagnosis of hydatid cyst, and death was attributed to cardiac arrhythmias. Pathologists should keep in mind that hydatid cysts can develop anywhere in the body. Solitary cardiac cyst is rare and can simulate a “silent bomb”. Unfortunately, sudden death remains the frequent manner of revelation of this disease in endemic areas.

Giant cardiac hydatid cyst causing sustained ventricular tachycardia. Successful surgical treatment

Cardiac involvement of hydatid disease is rare. In Peru, a country with a high prevalence of this infectious disease, few cases of cardiac hydatid disease have been reported. We present the case of a man with a cardiac hydatid cyst of more than 10 cm in diameter that debuted with malignant arrhythmia and successfully treated with surgery.

Incidental Left Ventricular Myocardial Hydatid Cyst - A case report

Hydatid disease is an indolent parasitic infection by a microorganism, echinococcosis granulosis. The disease can infect almost any human organ but is exceedingly rare involving the mediastinum and the heart. It can be lethal if complications occur. CT scan is the modality of choice for the diagnosis of the disease. The coverage of cardiac structures in the abdominal CT scan survey may be helpful for the detection of possible cardio-mediastinal hydatid disease. The authors present a case of hydatid cyst in the left ventricular wall alongside hepatic hydatid cysts. The definitive treatment includes surgery under cardiopulmonary bypass and needs to be treated as soon as it is diagnosed to prevent lethal complications.

Intracardiac masses: Single center experience within 12 years: I-MASS Study

Objective

The aim of this cross-sectional, retrospective, descriptive study was to review and classify cardiac masses systematically and to determine their frequencies.

Methods

The medical records of 64,862 consecutive patients were investigated within 12 years. Every patient with a cardiac mass imaged by transthoracic echocardiography (TTE) and confirmed with an advanced imaging modality such as transesophageal echocardiography (TEE), computed tomography (CT) and/or cardiac magnetic resonance imaging (CMR) was included. Acute coronary syndromes triggering thrombus formation, vegetations, intracardiac device and catheter related thrombi were excluded.

Results

Data demonstrated 127 (0.195%) intracardiac masses consisting of 33 (0.050%) primary benign, 3 (0.004%) primary malignant, 20 (0.030%) secondary tumors, 3 (0.004%) hydatid cysts and 68 (0.104%) thrombi respectively. The majority of primary cardiac tumors were benign (91.67%), predominantly myxomas (78.79%), and the less malignant (8.33%). Secondary cardiac tumors were common than the primary malignant tumors (20:3), with male dominancy (55%), lymphoma and lung cancers were the most frequent. Intracardiac thrombi was the majority of the cardiac masses, thrombi accompanying malignancies were in the first range (n = 17, 25%), followed by autoimmune diseases (n = 13, 19.12%) and ischemic heart disease with low ejection fraction (n = 12, 17.65%).

Conclusions

This retrospective analysis identified 127 patients with cardiac masses. The majority of benign tumors were myxoma, the most common tumors that metastasized to the heart were lymphoma and lung cancers, and the thrombi associated with malignancies and autoimmune diseases were the most frequent.

Cardiac hydatid cyst presenting as ventricular arrhythmia: a case report

Background

Hydatid disease caused by Echinococcus granulosus commonly involves the liver followed by lungs. Cardiac involvement is a rare occurrence and presents a challenging scenario.

Case presentation

Our case describes a middle-aged gentleman who presented to the emergency room with an episode of sudden loss of consciousness resulting from ventricular tachycardia. After successful cardiac resuscitation, the patient underwent imaging that showed a lesion compatible with hydatid cyst. Surgical treatment with pharmacologic coverage was provided which resulted in good clinical outcome.

Conclusions

The case highlights rare occurrence of isolated cardiac hydatid disease presenting as cardiac arrhythmia in contrast to its common routine outpatient presentation involving the liver and lungs. Good knowledge of the unusual presentations and its epidemiology is essential to the proper management of such patients.

Echinococcosis in both heart and lungs, the first case reported in Albania

An 11-year-old male was admitted with cough and fever for the last 4 days and also complained of pain in the right lung for some weeks. The boy did not show any other symptoms and his past medical history was unremarkable as well. The radiologist findings showed an aspect that suggested for echinococcosis.At first, it was realised the heart intervention. About a 2-month period later, the child underwent another cyst removal in lung. He had begun taking albendazole 5 days before the heart intervention. The therapy was continued until the lung intervention and for 12 weeks post-operatively. The patient had an uneventful recovery and after about 4 years.

Cardiac hydatid cyst: 2 case reports

Hydatidosis is a parasitic disease that is still prevalent in regions that rear farm animals, notably along the Mediterranean coast. The liver and lungs are most commonly involved. Cardiac hydatidosis has been reported infrequently even in countries in which hydatid disease is endemic. This entity must be known because when undiagnosed and untreated, the risk of fatal complications increases. We report 2 cases of cardiac echinococcal cysts in young men. The first case is an incidentaloma in a patient admitted for pancreatitis. The second case is about a patient admitted for dyspnea. CT scan and MRI were performed showing intraventrucular cystic mass with a calcified wall which was very suggestive of a hydatid cyst diagnosis. We would like to emphasize the relevance of imaging in this context and shade some light on imaging diagnostic tools.

Surgical excision of a cardiac hydatid cyst from the right ventricle in a child

Reporting the rare cardiac localization of hydatid disease in the right ventricle of a child, and underlining the importance of early diagnosis and treatment to avoid severe and life-threatening complications.

Extensive pulmonary artery embolisation caused by cardiac hydatid cyst rupture

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.

A 19-Year-Old-Woman With Backache, Hemoptysis, and Hypereosinophilia

CASE PRESENTATION

A 19-year-old woman presented to our ED with complaints of backache and massive hemoptysis. Her medical history included acute dyspnea that developed within hours caused by angioneurotic edema 6 months earlier. Two days later, she was given thrombolytic treatment because of massive pulmonary thromboembolism. She had been given methylprednisolone 4 mg and tinzaparin sodium 0.7 mL subcutaneously and was still under treatment on the current admission. She had no history of smoking, alcohol, or oral contraceptive use, surgery, trauma, recent travel, clotting disorders, or familial diseases.

Multimodality imaging of an interventricular septum hydatid cyst

BACKGROUND

Cardiac hydatid over the interventricular septum is extremely rare. Echinococcus infests humans as an accidental host. Echocardiography usually clinches the diagnosis of cardiac hydatid. However, multimodality imaging including cardiac magnetic resonance (CMR) imaging, computed tomography (CT), and positron emission tomography (PET) helps in supporting the diagnosis and surgical planning.

CASE PRESENTATION

We present a 29-year-old male who presented with dyspnea and was found to have cardiac hydatid on the interventricular septum on echocardiography. CT and CMR clinched the diagnosis. CT pulmonary angiography showed extensive pulmonary thromboembolization and cavitary consolidation in lungs. PET showed no active uptake in cardiac hydatid. Post-surgical enucleation of the cyst his hypotension worsened and succumbed.

CONCLUSION

Cardiac hydatid has poor prognosis. Multimodality imaging helps in confirming the diagnosis and surgical planning.

Cardiac Echinococcosis Associated with Other Organ Involvement: Report of Two Challenging Cases

•

Cardiac echinococcosis is a rare but potentially fatal manifestation of hydatid disease.

•

Antiparasitic agents with surgical cyst excision is the treatment of choice.

•

Heart team decision-based management is warranted in cases of other organ involvement.

Primary pericardial hydatid cyst in an asymptomatic butcher

Hydatid cyst is a serious parasitic infection in endemic areas. Cardiac hydatid cyst is not a common presentation, and primary pericardial hydatid cyst is rare. Echocardiography, CT, and MRI are important in diagnosing and locating cardiac echinococcosis. Herein, we present the case of an asymptomatic butcher with primary pericardial hydatid cyst and its successful treatment.

Hydatid disease of the interventricular septum: Echocardiographic and computed tomography findings

Hydatid disease (HD) is prevalent in South Africa, with cardiac HD being a rare but important manifestation to recognise and diagnose. An incidental finding on computed tomography (CT) of the chest in a patient with pulmonary HD prompted further multimodality imaging, which confirmed the presence of cardiac HD involving the interventricular septum. This case report focuses on imaging findings related to cardiac HD, as demonstrated by the CT of the chest and two- and three-dimensional transoesophageal echocardiography. Multimodality imaging is essential to assist in making a diagnosis and providing a detailed assessment of patients with cardiac HD.

Cystic echinococcosis of the interventricular septum: a rare clinical presentation

Cystic echinococcosis caused by infection with the larvae form of Echinococcus granulosus remains highly endemic and constitutes a public health concern in some regions of the world. In this case report, we present a rare children case of interventricular hydatid cyst with a size of approximately 5 cm and its successful treatment.

Case 274: Cardiac Echinococcus

HistoryA 47-year-old Sudanese man without a known remarkable medical history presented to the emergency department for a syncopal episode. The patient denied chest pain, dyspnea, focal weakness, or prior similar episodes. He was originally from north Sudan and eventually moved to Saudi Arabia, where he worked as a farm manager before emigrating to the United States years ago. Physical examination findings and routine laboratory values, including complete blood count and basic metabolic panels, were normal. Electrocardiography revealed nonspecific T-wave inversions, and a series of cardiac biomarkers were negative. A contrast material-enhanced CT angiography pulmonary embolism protocol and cardiac MRI were performed for further evaluation.

Surgical Management of Cardiac Hydatid Cyst and the Residual Intramural Ectocyst

The cardiac hydatid cyst (HC) is a rare pathology and mostly is endemic in livestock raising countries. Patients do not have a specific presentation so it is mainly a diagnosis based on imaging. Finding HC anywhere in the body warrants looking for another hydatid in other organs. This is a case report of a young male who presented with nonspecific symptoms and during diagnostic workup, it happened that he has combined hepatic and cardiac HCs. The cardiac cyst was located intramurally in the interventricular septum and expanding down mostly to the left side of the diaphragmatic surface of the heart and partly crossing intramurally to the diaphragmatic surface of the right ventricle. Emergency open-heart surgery was performed; the endocyst was removed while intramural ectocyst was drained to prevent potential future residual space.

Primary cardiac hydatid cyst presenting with massive pericardial effusion: a case report

BACKGROUND

Cardiac hydatidosis is a rare manifestation of Echinococcus infection. It represents 0.5 to 2% of hydatic disease (Mustafa et al., Can J Cardiol 22:2, 2006). The most common localization is the myocardium of the left ventricle but can also touch the right ventricle, atrium, pericardium, interventricular septum, and pulmonary artery. Clinical presentation is varied ranging from clinical latency or minor symptoms to cardiogenic shock and sudden death. The present case describes a primary pericardial hydatid cyst, a very exceptional localization of cardiac hydatidosis, which can lead to a delayed diagnosis or to an erroneous treatment that can expose the life of the patient to complications and death if it is not considered. Diagnosis can be established by cardiac imaging and hydatid serology. Therapy management should combine both surgery and medical treatment by albendazole or mebendazole.

CASE PRESENTATION

We report a 70-year-old woman from Sale, who was admitted for dyspnea New York Heart Association (NYHA) class IV evolving in a febrile context with signs of right heart failure related to a rupture of a primary pericardial hydatid cyst with pre-tamponade. The diagnosis was confirmed by echocardiography, computed tomography scan (CT scan), and hydatic serology, and the patient was operated and put on albendazole for 3 months with favorable clinical course.

CONCLUSIONS

The aims of this article are to consider the diagnosis of cardiac hydatid cysts in the presence of pericardial effusion, especially if there is a prior history of hydatid disease, a contact with animals, or when it occurs in an endemic country, and to be able to make a differential diagnosis with cardiac imaging in order to avoid its complications and to guide the management.

Thoracic hydatid disease: A radiologic review of unusual cases

Hydatid disease or echinococcosis is a zoonotic parasitic disease. The lung is the second most commonly affected organ after the liver. Intra-thoracic and extra-pulmonary hydatid disease is uncommon and may involve the pleura, mediastinum, heart, diaphragm, and chest wall. Unusual locations or complications of thoracic hydatid disease may pose a diagnostic challenge. We present imaging findings of cases with unusual location and presentations of thoracic hydatid disease with emphasis on their clinical implications.

Isolated cardiac hydatid cyst presented as myopericarditis: A case report

Hydatidosis commonly affect the liver and lungs but in rare cases, it can involve heart tissue. A 42-year-old man from urban areas of Khorasan Razavi province, northeastern Iran, was referred to the cardiac clinic with palpitation, and atypical chest pain in 2018. Large pericardial effusion, reduced left ventricle systolic function was found. A cystic-like lesion was also seen in inter-ventricular septum in echocardiography and high-resolution computed tomography (HRCT). Urgent cardiac surgery was done because of echocardiographic evidence of tamponade. Although the serologic analysis was negative for hydatidosis, surgical excision of cyst and the subsequent histopathological findings revealed a hydatid cyst. In endemic areas, hydatidosis should be considered in differential diagnosis of any cystic-like lesions, even if the serological analysis is negative.

Surgical overview of cardiac echinococcosis: a rare entity

OBJECTIVES

The purpose of this study was to describe our experience with the presentation and management of cardiac echinococcosis and the outcomes.

METHODS

We performed a retrospective study from January 2012 to September 2017 in 10 patients operated on for cardiac echinococcosis. There were 6 men and 4 women; the age range was 17-55 years (mean age, 35.9 ± 12.04 years). Among the 10 patients, 3 had multiple cysts and of the 7 patients with a solitary cyst, 5 cysts were in the left ventricle, 1 was in the right ventricle and 1 was in the interventricular septum. All patients were evaluated with electrocardiography, transthoracic echocardiography, computed tomography/magnetic resonance imaging of the thorax, ultrasound examinations of the abdominal organs, haemagglutination tests and histopathological examination of the cyst.

RESULTS

Nine operations were performed using cardiopulmonary bypass. One patient with a pericardial cyst was operated on with a beating heart with cystectomy and partial pericardiectomy. Preoperatively, all patients received albendazole for 2 weeks except for 1 patient who had an emergency operation. Albendazole was continued postoperatively in all patients for 12 weeks. There were no postoperative complications. No recurrences have been observed so far.

CONCLUSIONS

Cardiac echinococcosis is an infrequently encountered entity, but with clinical suspicion and early diagnosis it can be successfully managed with good outcomes.

Echinococcosis in left ventricle: a case report

INTRODUCTION

Echinococcosis, also called hydatid disease, is a common parasitic infection of the liver. However, echinococcus lesions rarely involve the heart, especially in children.

PATIENT CONCERNS

An 8-year-old child from grazing areas of northwest China was referred to our hospital for the complaint of inpersistent precordial chest pain and left upper quadrant pain for 3 years. Palpation showed hepatomegaly, abdominal palpable mass while inspection abdominal distension. Routine blood tests were within the normal ranges.

DIAGNOSIS

Combining the life history in pasture area, imaging features and serology results, it was consistent with the diagnosis of cardiac echinococcosis.

INTERVENTIONS

Surgery was performed to evacuate cyst liquid and remove the internal capsule of the cyst.

OUTCOMES

There was no cystic lesion in heart on ultrasound and her physical condition improved significantly after the surgery. The patient died of hepatic hydatid cyst rupture due to refusing high-risk surgical treatment and other treatment.

LESSONS

We presented a rare case of cystic echinococcosis involving left ventricle in a child, and surgery is an alternative and effective therapy for this lesion due to the cyst rupture or leakage that can result in anaphylaxis. The typical imaging features of the cardiac echinococcosis on cardiac magnetic resonance are presented. Patient prognosis relies on proper treatment of all lesions.

The imaging appearances of various pericardial disorders

The pericardium could be involved in a variety of clinical disorders. The imaging findings are not specific for an individual pathology in most of the cases; however, patient’s clinical history may guide radiologist to a definitive diagnosis. Congenital absence of the pericardium could be recognized with the imaging appearance of interposed lung tissue between the main pulmonary artery and aorta. Pericardial effusion is a non-specific condition that may occur due to inflammatory, infectious, and neoplastic disorders. Cardiac tamponade may occur in case of massive or rapid accumulation of fluid in the pericardial sac. Pericardial calcification is a common and easily identified entity on a computed tomography (CT) scan. Presence of calcification and/or fibrosis may result in pericardial constriction. Nevertheless, the pulsation of an adjacent coronary artery may prevent calcification formation in a focal area and consequently may result in pericardial diverticulum containing epicardial fat and coronary artery. The imaging findings encountered in patients with pericardial hydatid disease and Erdheim-Chester disease may mimic those of pericardial neoplasia. Pericardial adhesions and pedicled fat flaps may cause confusion on a CT scan in the post-surgical period following cardiac surgery. Pericardial fat necrosis can be diagnosed by CT in patients with chest pain. The radiologists should be familiar with the medical devices placed in pericardial space for certain individual indications. A pericardial patch and temporary epicardial pacemaker wires could be identified on a CT scan.

A cardiac hydatid cyst mimicking a pericardial tumour in a paediatric case

Cardiac hydatid cysts are a rare presentation of hydatid cyst disease in the body, with a reported cardiac involvement rate of <2%. The left ventricle is the most common site of cardiac involvement. Here, we report a patient with a hydatid cyst that ruptured into the pericardium after producing an aneurysm on the right ventricular free wall, appearing as fibrinated fluid and a solid mass lesion in the pericardium. Our aim in this case report was to emphasise that the possibility of a hydatid cyst should not be overlooked in the differential diagnosis of pericardial tumours.

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.

[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.

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

We report a 57-year-old man presenting with symptoms of sharp pricking, exertional retrosternal chest pain multiple times, each episode lasting for a few seconds. On evaluation, the ECG of the patient showed normal sinus rhythm with T wave inversions in leads V1-V3. Troponin T test was negative. Transthoracic echocardiography showed a globular mass in the interventricular septum. Cardiac MRI was suspicious of the lesion to be a hydatid cyst. Surgical excision of the lesion followed by histopathology was confirmatory of hydatid cyst.

Magnetic resonance imaging characteristics of cardiac hydatid cyst

PURPOSE

The purpose of this article is to describe the magnetic resonance imaging (MRI) features of cardiac hydatid disease and show the specific findings in the diagnosis of hydatic cysts.

MATERIALS AND METHODS

A retrospective review of cardiac MRI records between 2015 and 2017, 7 patients (3 males, 4 females; age range: 14-74) were identified with the histologic diagnosis of cardiac hydatid disease. Cardiac MRI examinations were performed in order to investigate the cardiac cystic-solid lesion obtained via previous echocardiography (ECG) and thorax computed tomography. 1.5 Tesla magnetic field power generation capacity was used and the images were acquired with ECG trigger.

RESULTS

There is variation in signal characteristics of cysts on T1-weighted and T2-weighted images. Early contrast enhancement was not observed in the any of lesions on contrast-enhanced series. In all lesions examined, peripheral contrast enhancement was observed in the late contrast enhanced series, independent from the internal structure and signal intensity.

CONCLUSIONS

MRI reveals the exact anatomic location and nature of the cyst structures. Peripheral enhancement of non-enhancing lesion is very valuable for diagnosis of cardiac hydatids on MRI.

Left ventricular hydatid cyst mimicking acute coronary syndrome

Hydatid disease is caused by the larvae of Echinococcus granulosus. Domestic dogs and cats are the primary carriers of echinococcal organisms. In some particular regions of the world, this parasitic infection is still endemic. Despite the fact that hydatid disease is most frequently located in the liver (50%-70% of cases) and the lungs (20%-30% of cases), it can occur in any organ or tissue. However, intracardiac localization of hydatid cyst is very rare and it is found in less than 2% of the cases. Cardiac involvement can be caused by systemic or pulmonary circulation or direct spread from adjacent structures. After the cardiac hydatid cyst remained asymptomatic for many years, the cyst opens into the pericardium, causes cardiac tamponade, and mimics acute coronary syndrome, or it may get into the circulation and cause anaphylactic shock, which happens rarely. Because clinical signs and symptoms of cardiac hydatid cyst are not specific and varied, it may be difficult to diagnose this disease. It is critical to diagnose cardiac involvement early and perform prompt surgical intervention. Imaging findings of a patient who had a left ventricular wall cardiac hydatid disease are presented here.

A giant cardiac hydatid cyst presenting with chest pain and ventricular tachycardia in a pregnant woman undergoing cesarean section

Cyst hydatid disease is an infectious disease caused by development of the larval form of Echinococcus granulosus in humans. Cardiac involvement of this disease is a rare condition, and if present, it is most commonly located in the left ventricle. Interventricular septal involvement is observed only in 4% of these cases. Herein, we report a case of cyst hydatid located at interventricular septum causing chest pain and ventricular tachycardia during cesarean section.

Cardiac Hydatid Cysts: Computed Tomography and Magnetic Resonance Imaging Findings of the 5 Cases

OBJECTIVE

In this article, we aimed to review the computed tomography (CT) and magnetic resonance imaging (MRI) findings of cardiac hydatid disease.

CONCLUSIONS

Regarding the diagnostic work-up of cardiac hydatid disease, CT and MRI are complimentary techniques. Whereas CT effectively depicts wall calcifications, MRI reveals the exact anatomic location and nature of the internal and external structures and is the technique used for the early diagnosis, assessment, and follow-up of patients with cardiac hydatid disease.