Bilateral hydatid cyst of pulmonary arteries: MR and CT findings

Hydatid Pulmonary Embolism: A Case Report and Literature Review

Patient: Female, 58-year-old

Final Diagnosis: Pulmonary embolism caused by hydatid cyst

Symptoms: Chest and back pain • hemoptysis • shortness of breath

Medication:—

Clinical Procedure: —

Specialty: Infectious Diseases • Pulmonology • Radiology

Is There Any Role of Pulmonary Endarterectomy in Pulmonary Arterial Hydatidosis?

BACKGROUND

Hydatid Cyst is a zoonosis caused by Echinococcus granulosis. Pulmonary artery involvement is a rare condition. The aim of this study was to review our experience in the surgical treatment of pulmonary arterial hydatidosis.

METHODS

Data were collected prospectively for consecutive patients who underwent pulmonary endarterectomy and had a diagnosis of hydatidosis at or after surgery.

RESULTS

Eight patients (two male, six female, mean age, 31.25±13.68 years) with hydatidosis were defined. Only one patient presented with hemoptysis, while the rest of the patients reported exertional dyspnea as their main symptom. Cardiac hydatidosis associated with pulmonary arterial involvement was noted in one patient. The mean time interval for duration of disease was 12±24.29 months before PEA. Mortality was observed in two patients due to massive hemoptysis in one and right heart failure in one. No anaphylactic reaction was observed. Significant difference was detected in mean pulmonary vascular resistance as decline from 442.38±474.20 to 357.25±285.34 dyn/s/cm^-5 following surgery (p: 0.011). Two patients had recurrence of the disease following a median follow-up of 9.1 months All survivors improved to New York Heart Association functional class I and II.

CONCLUSIONS

Pulmonary arterial hydatidosis may mimic chronic thromboembolic pulmonary hypertension and these patients can be diagnosed with pulmonary endarterectomy. Surgery may be a therapeutic option for patients who do not respond to medical therapy if the cystic lesions are surgically accessible. Pulmonary endarterectomy should be performed only in expert centers because of the high risk of perioperative morbidity, mortality, and postoperative recurrence.

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.

Case Report of Hydatid Cyst in the Pulmonary Artery Uncommon Presentation: CT and MRI Findings

Background

Hydatid cysts can be found in any organ. In adults, the liver and lungs are the most common locations; hydatid cysts in the pulmonary artery are rare.

Clinical Case

We present the case of an 86-year-old female with a history of hepatic hydatid cyst since 2012, who presented with complaints of chronic productive cough, yellowish-green sputum, and dyspnea. CT and MRI showed multiseptate hydatid cysts in the right pulmonary artery.

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 case of pulmonary artery hydatid cyst observed on endobronchial ultrasound

Hydatid cyst (HC) is a parasitic disease that may involve many organs, especially the lung and the liver. Pulmonary artery location of the hydatid cyst is extremely rare, but it may cause life-threatening complications. We report a case of a hydatid cyst that completely filled the left main pulmonary artery and its distal part without cardiac involvement. Thoracic computed tomography showed filling defects in the pulmonary arteries. Endobronchial ultrasound was performed for differential diagnosis and it showed a cystic lesion. Hydatid cyst-specific IgE and hem agglutination test results were positive. In the literature, cases like this in which the diagnosis of pulmonary hydatid cyst is made by endobronchial ultrasound are not usually seen. Although many imaging modalities such as plain chest radiography, cross-sectional imaging (MDCT and MRI), echocardiography and conventional pulmonary angiography have been used in the diagnostic approach, we recommend endobronchial ultrasound for the differential diagnosis of cases with cystic formation.

[Hydatic pulmonary embolism: a rare complication of hepatic hydatid cyst]

Hepato-pulmonary hydatidosis is a parasitic disease common in Mediterranean countries. Hydatid pulmonary embolism is extremely rare and is due to rupture of a cardiac hydatid cyst or, more rarely, rupture of a hepatic hydatid cyst. We report three cases of hydatid pulmonary embolism secondary to rupture of a hydatid cyst into the inferior vena cava. Thoracic imaging, mainly CT angiography and MRI, was important for both the diagnosis and decisions on treatment. The prognosis of intra-arterial pulmonary hydatid cyst is poor because of the risk of acute fatal complications such as anaphylactic shock and vascular rupture and also of chronic progression to cor pulmonale and respiratory failure. The therapeutic management is difficult and often only partially effective hence the importance of focusing on preventative treatment.

Pulmonary artery embolism due to a ruptured hepatic hydatid cyst: clinical and radiologic imaging findings

Hydatid pulmonary embolism is an uncommon condition resulting from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst into the venous circulation. We report a rare case with multiple intra-arterial pulmonary hydatid cyst emboli originating from a hepatic hydatid cyst ruptured into the hepatic segment of the inferior vena cava. We present the ultrasonography findings of hepatic hydatid cyst and multidetector computed tomography pulmonary angiography images demonstrating both multiple hydatid cyst emboli and their hepatic origin.

Cavitating atrial myxoma mimicking hydatid cyst on echocardiography: utility of cardiac magnetic resonance imaging and computed tomography for diagnosis and preoperative evaluation

A cavitating cardiac mass may represent various etiologies, the most common being hydatid cyst, myxoma, and thrombus. Diagnosis is crucial as treatment strategies are very different. Although echocardiography is the initial imaging modality for a suspected cardiac mass, it does not allow for accurate tissue characterization. Cardiac magnetic resonance imaging helps to confirm the diagnosis as it incorporates a variety of pulse sequences and assesses the perfusion and delayed enhanced characteristics of the mass and myocardium. Multidetector computed tomography angiography is useful for preoperative demonstration of coronary arteries and tumor vascularity. This report describes a case of cavitating atrial myxoma suspected to be a hydatid cyst on echocardiography. Magnetic resonance imaging and multidetector computed tomography helped in the complete diagnostic workup.

[Hydatid disease diagnosed following a pulmonary embolism]

Hydatidosis is a parasitic disease found worldwide, particularly in Mediterranean countries, caused by Echinococcus granulosis infection. Humans are an intermediate and accidental host in the cycle of this parasite. The hydatid pulmonary arterial embolism is extremely rare, usually arising in the heart or the liver. We report a case of hydatid pulmonary embolism explored with multidetector scanner and MRI, and confirmed at pathology of the operative specimen. To our knowledge, this is the first case of inaugural hydatid pulmonary arterial embolism found on CT scan establishing the diagnosis of the disease in a patient who had no other location of hydatid cyst.

Hydatid disease of right ventricle and pulmonary arteries: a rare cause of pulmonary embolism--computed tomography and magnetic resonance imaging findings (2009: 5b)

Hydatid disease can occur anywhere in the body and can demonstrate different imaging features that vary according to growth stage, associated complications, and affected tissue. Cardiovascular system involvement of hydatid disease is very rare. In this article, we present the cardiac magnetic resonance (MR) and thorax computed tomography (CT), MR angiography (MRA) findings of hydatid cysts located in the right ventricle and pulmonary arteries after surgical removal of hepatic hydatid cysts.

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

OBJECTIVE

The purpose of this article is to review the CT and MRI findings of cardiac hydatid disease.

CONCLUSIONS

CT and MRI are helpful for localizing and defining the morphologic features of hydatid cysts. Specific signs include calcification of the cyst wall, presence of daughter cysts, and membrane detachment. CT best shows wall calcification, whereas MRI depicts the exact anatomic location and nature of the internal and external structures.

Hydatid cysts of the bilateral pulmonary arteries and left ventricle wall: computed tomography and magnetic resonance imaging findings

Echinococcal cysts located inside the pulmonary artery are extremely rare. The cause is usually rupture of intracardiac cysts or, more rarely, dissemination from a hepatic focus. The case of a 39-year-old patient with multiple hydatid cysts in the right and left pulmonary arteries and left ventricle wall is reported. The patient had undergone surgery for a hepatic hydatid cyst 10 years ago. Multidetector computed tomography angiography and magnetic resonance imaging were performed for the diagnostic evaluation.

Echinococcus of the pulmonary artery: CT, MRI and MRA findings

The location of echinococcal cysts inside pulmonary artery is extremely rare. The cause is usually rupture of intracardiac cysts. We report a case of a 67-year-old patient with known lung hydatid disease whose main clinical presentation was dyspnea. The patient did not have any surgery in the past. The importance of the present case lies in the demonstration of the MR angiographic findings.