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Kort I, Hmandi O, Bekir O, Belhaj A, Jemail L, Allouche M, Belhadj Kacem L, Rammeh S, Ben Khelil M. Sudden death due to a massive hydatid pulmonary embolism secondary to a cardiac cyst rupture. J Forensic Sci 2022; 67:2101-2105. [PMID: 35686886 DOI: 10.1111/1556-4029.15075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/20/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Abstract
Cardiac echinococcosis is rare, and its clinical evolution is slow and asymptomatic until complications occur such as sudden death. Although more frequent in endemic countries, hydatid disease should be known by forensic specialists with regard to the migration flows of people from zones with high endemicity and who are likely to die from infection. We report an autopsy case of a 33-year-old male without any medical history who presented to the emergency room with shortness of breath, chest tightness, tingling all over the body and faintness without fever. He died suddenly before the medical examination. Autopsy showed no traumatic injuries or signs of violence. A cardiac 7 cm multivesicular hydatid cyst situated on the interventricular septum and the interatrial septum was observed. The cyst was ruptured with a massive hydatid pulmonary embolism. Hydatid cysts were also observed in the lungs. No signs of anaphylactic shock were found. The diagnosis of hydatid cyst was confirmed by histopathological examinations. Our case report highlights the mechanisms of occurrence of cardiac echinococcosis and hydatid pulmonary embolism as a complication, as well as the autopsy findings and the precautions needed by the forensic doctor.
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Affiliation(s)
- Ikram Kort
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ons Hmandi
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Olfa Bekir
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Azza Belhaj
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Leila Jemail
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Allouche
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Legal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Linda Belhadj Kacem
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Pathological Anatomy and Cytology Charles Nicolle Hospital, Tunis, Tunisia
| | - Soumaya Rammeh
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.,Department of Pathological Anatomy and Cytology Charles Nicolle Hospital, Tunis, Tunisia
| | - Mehdi Ben Khelil
- Department of Legal Medicine, Trauma and Burn Center, Ben Arous, Tunisia
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2
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Jain PK, Malik V, Divya A, Narula J, Hote M. Interventricular septal hydatid cyst: Transesophageal echocardiography as a therapeutic tool during bypass. Ann Card Anaesth 2016; 18:421-4. [PMID: 26139754 PMCID: PMC4881693 DOI: 10.4103/0971-9784.159817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cystic echinococcosis (hydatid disease) arising from infestation with a larval or adult form of the Echinococcus granulosus tapeworm is endemic in certain states of India, but affecting interventricular septum (IVS) solitarily is a scarce phenomenon. We present a rare case of transesophageal echocardiography guided management of IVS hydatid cyst even during cardiopulmonary bypass, which presented with a rather unusual complaint of repeated syncope.
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Affiliation(s)
| | - Vishwas Malik
- Department of Cardiothoracic Vascular Anaesthesiology, All India Institute of Medical Science, New Delhi, India
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3
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Ozbudak E, Durmaz D, Arıkan AA, Halici U, Yavuz S, Emre E. Incidentally detected cardiac cyst hydatid after blunt thoracic trauma. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2014; 47:160-2. [PMID: 24782970 PMCID: PMC4000877 DOI: 10.5090/kjtcs.2014.47.2.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/14/2013] [Accepted: 09/17/2013] [Indexed: 11/16/2022]
Abstract
Cardiac involvement in hydatid disease is more seldom than the involvement of the liver and the lungs. Cardiac cyst hydatid disease is diagnosed incidentally or by means of symptoms such as dyspnea and angina pectoris. Here, we present the case of a 45-year-old male patient who underwent open heart surgery for a randomly detected cardiac cyst hydatid during investigations carried out in a healthcare institution after accidentally falling from height. On the other hand, this patient did not have any complaints associated with hydatid disease before this event.
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Affiliation(s)
- Ersan Ozbudak
- Department of Cardiovascular Surgery, Kocaeli University Faculty of Medicine, Türkiye
| | - Duygu Durmaz
- Department of Cardiovascular Surgery, Kocaeli University Faculty of Medicine, Türkiye
| | - Ali Ahmet Arıkan
- Department of Cardiovascular Surgery, Kocaeli University Faculty of Medicine, Türkiye
| | - Umit Halici
- Department of Cardiovascular Surgery, Samsun Training and Research Hospital, Türkiye
| | - Sadan Yavuz
- Department of Cardiovascular Surgery, Kocaeli University Faculty of Medicine, Türkiye
| | - Ender Emre
- Department of Cardiology, Kocaeli University Faculty of Medicine, Türkiye
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4
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Dogra N, Puri GD, Kumar B. Isolated pericardial echinococcosis: Perioperative transesophageal echocardiographic evaluation. J Cardiovasc Dis Res 2013; 4:149-51. [PMID: 24027375 DOI: 10.1016/j.jcdr.2012.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/12/2012] [Indexed: 11/28/2022] Open
Abstract
Hydatid cyst (HC) is a human parasitic disease caused by the larval stage of Echinococcus granulosus. Cardiac involvement is rare and occurs in 0.5%-2% of patients with hydatid cyst, but isolated pericardial hydatid cyst is rarer still. We present two cases of isolated pericardial hydatid cyst who presented with precordial chest pain and dyspnea. In both the cases, HC were diagnosed by transthoracic echo (TTE), Computed Tomography/Magnetic Resonance and positive hydatid serology. Intraoperatively transesophageal echo (TEE) revealed unilocular transitional cystic lesion the transverse pericardial sinus in one case and multilobulated active cystic lesion in another. The report highlights the role of TEE in diagnosis and evaluation of cardiac HC. Both the cases underwent surgical resection followed by albendazole therapy to prevent recurrence.
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Affiliation(s)
- Neeti Dogra
- Department of Anaesthesiology and Intensive Care, Advanced Cardiac Centre, PGIMER, Chandigarh 160 012, India
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5
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Ilic S, Parezanovic V, Djukic M, Kalangos A. Ruptured hydatid cyst of the interventricular septum with acute embolic pulmonary artery complications. Pediatr Cardiol 2008; 29:855-7. [PMID: 18175164 DOI: 10.1007/s00246-007-9176-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Revised: 11/02/2007] [Accepted: 11/21/2007] [Indexed: 12/16/2022]
Abstract
Hydatid cysts located in the interventricular septum are especially rare but with the high risk for intracavitary rupture. We report a patient with acute pulmonary embolism caused by an isolated, ruptured hydatid cyst on the right side of the interventricular septum. Early diagnosis was made by echocardiography and positive serology. Pulmonary artery embolism was confirmed by angiography and the patient was operated on. Embolectomy was performed by removing multiple fragments of ruptured endocyst from the left pulmonary artery, followed by surgical closure of a cyst cavity. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome.
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Affiliation(s)
- Slobodan Ilic
- Department of Cardiothoracic Surgery, University Children's Hospital, Tirsova 10, Belgrade, Serbia and Montenegro.
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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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