Hydatid disease of the interventricular septum causing pericardial effusion

Cardiac hydatid cyst in the right ventricle - A rare case report of echinococcosis presentation

Introduction

The hydatid cyst (HC) of the right ventricle (RV) is an extremely uncommon and a serious location that can cause sudden death following pulmonary embolism, obstruction of the valvular orifice or anaphylactic shock.

Case presentation

We report a case of a 14 years-old girl with a HC of the RV. Surgical excision of the HC under Cardiopulmonary bypass (CPB) was successful in managing this rare case.

Clinical discussion

Cardiac HC is extremely rare. It represents only 0.5–2% of all hydatid cases. However, RV location is very severe. It has a tendency to rupture intracavitarily and causes sudden death in 30% of cases. Its diagnosis is based on echocardiography, computed tomography scan and magnetic resonance imaging. The surgical treatment under CPB with anthelmintic therapy seems to improve the prognostic outcomes.

Conclusion

Cardiac HC must be always suspected in endemic countries, especially in patients with a family history of HC.

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Hydatid cyst of the right ventricle is an extremely uncommon location.

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Right ventricle location is very severe that can cause sudden death in 30% of cases.

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The optimal treatment is still based on surgery under cardiopulmonary bypass with anthelmintic therapy.

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Hydatid cyst of the right ventricle should be diagnosed and treated early to prevent sudden death.

Helminthosis and eosinophilia in Spain (1990-2015)

The finding of blood eosinophilia in a patient is a relatively frequent reason to refer him/her to a Clinical Department of Infectious Diseases. The doctor usually intends to rule out a parasitic disease in the autochthonous population, travelers or immigrants. It is uncommon for an eosinophilia to be produced by protozoa infection, whereas helminth parasites are more frequently associated with an increase of eosinophil counts in the infected patient. Eosinophilia can be the only abnormal finding, or it could be part of more complex clinical manifestations suffered by the patient. Furthermore, many, but not all, helminth infections are associated with eosinophilia, and the eosinophil level (low, high) differs according to parasite stages, helminth species, and worm co-infections. The purpose of the present article is to carry out a systematic review of cases and case series on helminth infections and eosinophilia reported in Spain from 1990 to 2015, making a distinction between autochthonous and imported (immigrants and travelers) cases, and studying their relationship with immunodepression situations.

Study of Protoscolicidal Effects of Hypertonic Glucose on Protoscolices of Hydatid Cyst at Different Concentrations and Exposure Times

Surgical operation is the treatment of choice for hydatid cyst. To date, many protoscolicidal substances have been used for inactivation of hydatid cyst contents but most of these compounds may produce several side effects. The aim of this study was to evaluate the protoscolicidal effects of hypertonic glucose on protoscolices of hydatid cyst at different concentrations and exposure times. Protoscolices were obtained aseptically from the livers of slaughtered sheep at Qazvin abattoir, Iran. Protoscolices were exposed to different concentrations of hypertonic glucose (10%, 15%, 20%, 25%, 30%, 40%, and 50%) at different times (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, and 60 min). Viability of protoscolices was evaluated by 0.1% eosin and the movement of protoscolices flame cells. The highest protoscolicidal effect (100%) of hypertonic glucose was obtained at concentrations 40% and 50% following 40 and 20 min exposure times, respectively. Some protoscolicidal agents show a variety of dangerous complications such as biliary tract fibrosis and liver necrosis; however, hypertonic glucose especially at a concentration of 40% may demonstrate less side effects compared with glucose 50%. Further in vivo investigations are suggested.

Cardiac tamponade via a fistula to the pericardium from a hydatid cyst: case report and review of the literature

Although echinococcus is endemic in many sheep-raising areas of the world, cardiac involvement is rare. Cysts usually reach the heart by means of the coronary circulation, but other routes have been proposed. Pericardial tamponade due to a hydatid cyst has not yet been described in the literature. We present the case of a 46-year-old woman who presented to the Emergency Department with complaints of chest pain and mild dyspnea. Her medical history was positive for a liver hydatid cyst operation 26 years earlier. She was tachypneic, tachycardic, and hypotensive. Pleural and pericardial effusions were detected on transthoracic echocardiography. When she worsened clinically, pericardiocentesis was performed and she promptly improved. A fistula was detected between the liver and pericardium on computed tomography (CT) scan of the torso. Serologic test (agglutination) for Echinococcus granulosus was positive in a 1/32 dilution. A final diagnosis of mediastinal hydatic cyst was made, and a 4-week course of albendazol was given. Then the cyst was surgically excised, and the patient recovered without complications.

Recurrent Pulmonary Microemboli Secondary to Primary Cardiac Hydatidosis

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.

Complete Atrioventricular Block due to a Hydatid Cyst Located in the Interventricular Septum: A Case Report

We report a case of complete atrioventricular block and tricuspid valve insufficiency due to a cardiac hydatid cyst located in the interventricular septum that occurred in a 19-year-old male patient. Surgery was carried out with the help of cardiopulmonary bypass. The cyst was excised, and the interventricular septum was closed with an autologous pericardial patch treated with glutaraldehyde. The tricuspid valve insufficiency was repaired with annuloplasty. A dual-chamber epicardial pacemaker was implanted. The postoperative course was uneventful, and the patient was doing well 6 months after discharge. This is the first report of a cardiac hydatidosis case for which the repair of the interventicular septum, tricuspid annulopasty, and permanent pacemaker implantation were performed during the same operation.

Complex Reconstruction of Hydatid Cyst-Destructed Left Ventricle: A Case Report

OBJECTIVE

Echinococcus cyst in the heart as a life threatening condition has a rare incidence of only 0.5% to 2%.

MATERIAL AND METHODS

We have described the case of a 23-year-old patient with an echinococcus cyst localized in the inferoseptal and posterior wall of the left ventricle. In a random x-ray examination, a pathological formation in the left ventricle was found in a completely asymptomatic patient. Using a transthoracic echocardiography, the existence of a multilocular echinococcus cyst in the left ventricle was confirmed. The cyst, with a diameter of 8 cm, was located at the distal third of the septum toward the posterior wall. The diagnosis was confirmed with transesophageal echocardiography, computerized tomography, and magnetic resonance imaging. We excluded the existence of other noncardiac localizations of the echinoccosis. The patient had normal angiography. After 3 and a half years of unsuccessful treatment with benzimidazole, the patient was enrolled for a surgical treatment. After a medial sternotomy, during extracorporeal circulation, we performed warm-blood cardioplegy and approached complete excision of the cyst. The multilocular cyst was opened at the apex. We punctured the cyst and aspirated the dense co-liquated cystic mass, instillating hypertonic solution for prevention of cyst dissemination. The pericystic sheath was resected down to an intact myocardium. The septal defect was closed with 2 circular sutures.

RESULTS

The patient underwent the operation without any complications, and the patient's functions were stable following the intervention. Patient follow-up at 3 years showed no signs of relapse of the disease.

CONCLUSION

The surgical treatment is inevitable even when the location and approach technique are highly troublesome.

Right ventricle hydatid cyst requiring tricuspid valve excision

Hydatid cyst in the heart is uncommon, with cardiac involvement occurring in about 0.4-2% of all hydatid infestations. The right ventricle is only rarely involved accounting for 8% of cases. We report a case of a hydatid cyst located in the right ventricle involving the posterior papillary muscle requiring tricuspid valve excision.

Epidemiology, clinical manifestations and diagnosis of zoonotic cestode infections: an update

This paper reviews the literature on zoonotic cestode infections with specific reference to the years 1999-2003. The sources and prevalence of various zoonotic tapeworm infections caused by adult and larval stages of the genera Taenia, Echinococcus, Diphyllobothrium, Hymenolepis and Dipylidium continue to be an important cause of morbidity and mortality, not only in most underdeveloped countries but also in industrialized countries, particularly in rural areas or among immigrant groups from endemic areas. The review gives a detailed report on recent molecular epidemiological studies on the taxonomy and phylogenetic variations in Echinococcus granulosus, immunological tests and imaging techniques used in epidemiological surveys and clinical investigations of important adult and larval tapeworm infections of animals and humans. Larval stages or metacestodes of Taenia solium, Echinococcus spp. and pseudophyllidean tapeworms (Spirometra syn. Diphyllobothrium spp.) may reside in various tissues of their intermediate hosts, including humans. In particular, Cysticercus cellulosae (T. solium) and the larvae of E. granulosus, and E. multilocularis, which are predominantly located in the liver, lungs and central nervous system forming various types of cysts, lead to a complex of systemic diseases such as cysticercosis, cystic echinococcosis and alveolar echinococcosis, respectively. Relatively rare clinical manifestations are seen in the muscles, subcutaneous tissue, spleen, kidneys, bones and body cavities.

Cardiac hydatid cyst and pulmonary hydatidosis in a child

Hydatidosis in the lungs is unusual, and a cardiac localization occurs rarely. We report a child with cardiac hydatid cyst that developed during albendazole treatment for preceding multiple pulmonary hydatid lesions. The cardiac lesion was treated by surgical excision, and the pulmonary cysts improved with a combination of praziquantel and albendazole therapy.