Endocardial hydatid cyst: a rare presentation of echinococcal infection
Cardiology Department, Nemazee Hospital, Zand Avenue, PO Box 71935-1334, Shiraz, Iran
Received 24 October 2007; accepted after revision 7 November 2007.
* Corresponding author. Tel: +98 711 2277181; Fax: +98 711 2277182. E-mail address: draslani{at}yahoo.com
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A previously well 45-year-old male presented with 20 days of being generally unwell with a fever and dyspnoea on exertion. Transthoracic echocardiography was done and revealed a round cystic structure (3x3 cm) attached to the tricuspid valve. Multiple small calcified particles (daughter cysts) were also seen in the cyst which was most consistent with the diagnosis of Hydatid cyst. The serology for Echinococcus granulosus antibody was positive and confirmed the diagnosis. The patient was sent for cardiac surgery and hydatid cyst which was endocardial in location, and adherent to the tricuspid valve leaflets was the intraoperative finding. The patient improved and was discharged on long-term chemotherapy. The most common cite of cardiac involvement is the myocardium followed by the pericardium, whereas endocardial involvement is extremely rare. In the present study, we demonstrated a very rare case of endocardial hydatid cyst with attachment to the tricuspid valve.
Keywords: Echocardiography; Hydatid cyst
A previously well 45-year-old male presented with 20 days of being generally unwell with a fever and dyspnoea on exertion. His electrocardiogram showed sinus rhythm with T-wave inversion in inferior leads but his cardiac enzymes were normal. His erythrocyte sedimentation rate was 40 mm/h and complete blood count showed 28% eosinophilia. Chest X-ray was taken and revealed normal findings. Transthoracic echocardiography was done and revealed a round cystic structure (3x3 cm) attached to the tricuspid valve (Figure 1) (see Supplementary material online, Movie Clips 1 and 2). Multiple small calcified particles (daughter cysts) were also seen in the cyst (Figure 1B) which was most consistent with the diagnosis of hydatid cyst. The serology for Echinococcus granulosus antibody was positive and confirmed the diagnosis. A computerized tomography scan of the chest, abdomen, and pelvis showed no disease elsewhere. The patient was sent for cardiac surgery and hydatid cyst which was endocardial in location and adherent to the tricuspid valve leaflets was the intraoperative finding. The patient improved and was discharged on long-term chemotherapy.
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Hydatid disease is caused by a parasitic infection, most commonly Echinococcus granulosus. There are numerous cases from predominantly sheep-grazing rural areas in our country. The life cycle of this parasite is well described with the dog being the definitive host, the sheep being the usual intermediate host and human being the accidental host.1 Parasitic ingestion leads to bowel-wall invasion and spread via the portal circulation to the liver, which is the most common site of infection, followed by the lungs. Other sites of infection include the spleen, muscles, eyes, and heart.2 Cardiac involvement is rare and only occurs in 0.02–2% of cases of hydatid infection.3 Isolated cardiac involvement can occur but is extremely rare.4 Hydatid infection of the heart may occur via the coronary circulation or from intravascular pulmonary cyst rupture.2 Presentation can be variable related to the position, size, and restriction of normal cardiac function. Symptoms such as rhythm disturbances, ischaemia, haemodynamic effects, pulmonary or systemic embolization, pericardial tamponade, and rupture with anaphylaxis have all been reported.1,2 The most common cite of cardiac involvement is the myocardium followed by the pericardium, whereas endocardial involvement is extremely rare.4 Echocardiography can show cystic nature and location within the heart and also document any haemodynamic compromise to ventricular or valvular function. Both CT and MRI cannot only show the cardiac lesion, but also search for the disease elsewhere in the body. Currently, initial treatment is surgical resection (cystopericystectomy). Long-term treatment is usually with anti-parasitic chemotherapy (Albendazole), however recurrences are common.
In the present study, we demonstrated a very rare case of endocardial hydatid cyst with attachment to the tricuspid valve.
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Supplementary material |
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Supplementary material associated with this article can be found in the online version.
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References |
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- Beggs I. The radiology of hydatid disease—review. Amer J Roentgenol (1985) 145:639–48.
- Kurtoglu N, Ermeydan C, Akdemir R, Basaran Y, Dindar I. Interventricular septal hydatid cyst. Echocardiography (2000) 17:693–5.[CrossRef][Web of Science][Medline]
- Heyat J, Mokhtari H, Hajaliloo J, Shakibi JG. Surgical treatment of echinococcal cyst of the heart. J Thorac Cardiovasc Surg (1971) 61:755–64.[Web of Science][Medline]
- Thameur H, Abdelmoula S, Chenik S, Bey M, Ziadi M, Mestiri T, et al. Cardiopericardial hydatid cysts. World J Surg (2001) 25:58–67.[CrossRef][Web of Science][Medline]
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