Hydatid Cyst of the Heart

Cardiac cystic echinococcosis-A systematic review and analysis of the literature

Human cystic echinococcosis (CE) is a parasitic infection caused by the larval stage of the tapeworm Echinococcus granulosus sensu lato, primarily affecting the liver and lungs. Although the heart is affected in only 0.02-2% of all CE cases, a considerable number of cases have been, and continue to be, published. However, due to the rare occurrence of cardiac CE and the resulting lack of clinical trials, knowledge about various aspects of the disease remains limited. To obtain a clearer picture of anatomical, clinical, diagnostic as well as therapeutic aspects of cardiac CE, we systematically reviewed the literature published between 1965 and 2022. The anatomical pattern of the affected cardiac structures follows the extension of the supplying capillary bed. The majority of patients (82.7%) are symptomatic and present with prolonged non-specific symptoms such as dyspnoea, chest pain and palpitations. Acute complications generally derive from cyst rupture, occur in 18.3% of cases and manifest as embolism, pericardial tamponade, or anaphylactic reaction in 83.2%, 17.8% and 10.9% of these cases, respectively. As for CE cysts localized in other organs, the diagnosis of cardiac CE is made by imaging. Serology plays a minor role due to its limited sensitivity. Unlike abdominal CE cysts, cardiac CE cysts are usually resected independent of their stage (active/inactive), because their presence impairs cardiac performance and carries the risk of long-term sequelae. More than 80% of patients are treated with a single surgical intervention. We found a disease-related case fatality rate of 11.1%. Since local recurrence was reported up to 108 months and secondary CE up to 72 months after surgery, patients should be followed up for a minimum of 10 years.

Cardiac hydatid disease; a systematic review

BACKGROUND AND OBJECTIVES

Human cystic echinococcosis (CE), is a common health problem in low- and middle-income countries. Cardiac involvement is a relatively rare manifestation of Echinococcus infection. This study aims to summarize the evidence regarding the features of cardiac CE.

METHODS

Case series of the patients with cardiac CE, were included in this study. Non-English papers, case reports, reviews, letters, , commentaries, and conference abstracts were not included. A systematic search was conducted in PubMed and EMBASE databases and the risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist.

RESULTS

Out of 3985 results of the searches, finally 37 studies were included in this systematic review. Based on available evidence, cardiac involvement is an uncommon but serious presentation of CE which presents with some non-specific signs and symptoms. Dyspnea, chest pain, and palpitation are the most common symptoms of the disease and normal sinus rhythm is the most common Electrocardiogram (ECG) feature. The disease is not associated with high mortality in case of timely diagnosis and appropriate management.

DISCUSSION

Consecutive and complete inclusion of participants, statistical analysis, and appropriate reporting of the demographics were the sources of bias in the included studies. The exclusion of non-English papers was a limitation during the review process.

FUNDING

The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380).

REGISTRATION

This study was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42022381204).

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.

Multiple Hydatid Cysts in Rare Locations Treated with Albendazole: A Case Report

Hydatid cyst is a common disease between humans and animals. Foods that are contaminated with eggs of echinococcal species are the cause of hydatid disease. Although this parasite affects different organs, the liver and lungs are very susceptible but the cardiac hydatid disease is very rare. We report the case of a 33-year-old man admitted because of chest pain. Echocardiography had shown suspected round cyst in the myocardium. More diagnostic managements had demonstrated cystic lesion in the liver, spleen and lungs. There were also multiple cystic lesions in both lungs. He refused surgery and was taken to medical therapy. Myocardial involvement by hydatid cysts occurs very rarely. The main treatment approach for cardiac hydatid disease in patients should be surgery. The alternative treatment was done to those who refused surgical removal, adjuvant therapy such as albendazole for at least 1-6 months. Because myocardial involvement by hydatid cysts is uncommon, we decided to report this rare case.

A rare combination of cardiac and pulmonary cyst and review of the literature

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Combination of heart and lung hydatid cyst is rare.

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Echocardiography remains the most accurate diagnostic tool for cardiac hydatid cyst.

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Surgical treatment for cardiopulmonary hydatid cysts is necessary.

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Cardiac and pulmonary hydatid disease can undergo radical resection in one-stage.

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One stage surgery is safe and satisfactory, it decreases the hospital stay and costs.

Hydatid disease remains an important public health problem in endemic areas. We report a rare case of intramyocardial hydatid cyst of the right atrium along with a pulmonary hydatid cyst in a 16-year-old girl who was admitted to our hospital because of chest pain with recurrent episodes of fainting. One-stage surgery by median sternotomy under cardiopulmonary bypass was performed with excision of the hydatid cyst in the right atrium followed by the removal of the pulmonary hydatid cyst in the same session. Her postoperative recovery was uneventful. Based on this case, we emphasize, the rare combination of cardiac and pulmonary hydatid cyst. Another aspect that makes this case interesting is the location of the hydatid cyst at the right atrium, which is very rare. To the best of our knowledge, our case is the first to describe the combination of a hydatid cyst of the right atrium and the lung.

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.

Cardiac hydatid cyst in the right ventricle: An unusual case at a rare site

Hydatid disease is a parasitic infection by the larval stage of the tapeworm Echinococcus granulosus. It affects liver, lungs and rarely other organs. Medical imaging provide the basis for diagnosis. This case report describes an extremely rare location of cardiac hydatid cyst in the right ventricle of the heart. We describe a 23-year-old woman who presented with shortness of breath and productive cough. Laboratory investigations showed marked eosinophilia and anemia. Chest radiography and abdominal ultrasonography were unremarkable. Cardiac computed tomography (CT) identified two well-defined fluid densities in the right ventricle without contrast enhancement. A transthoracic echocardiography (TTE) showed two cystic lesions in the right ventricular cavity that was attached to the interventricular septum. Hydatid cyst was the most likely diagnosis followed by the possibility of a congenital cardiac cyst. An open-heart surgery with cardiac cystectomy was performed. Post-operative analysis of the resected specimens showed multiple hydatid cysts with living scolices of Echinococcus granulosus. The patient recovered uneventfully and was discharged on oral albendazole.

Analysis of hospital records of children with hydatid cyst in south of Iran

The clinical manifestations of hydatidosis are various and related to anatomic location. Defining frequent symptoms and signs of the disease is imperative for early management of it. The aim of this report was to analyse the clinical features of infected children with hydatid cysts located in different organs. In this study, medical charts of 57 children between 3 and 16 years of age with hydatid cyst admitted to Pediatric Wards of Nemazee Hospital were evaluated over a 12 year period (from 2003 to 2014, prospectively). All the epidemiologic, clinical, paraclinical and therapeutic data were collected. The frequencies of hydatidosis in males and females were 42.1 and 56.1%, respectively. Hydatid cysts were found in the liver and lungs in 59.6 and 33.3% patients respectively and 2 patients had an asymptomatic cyst in the heart with concomitant liver and lung cysts. The right upper quadrant pain (100%) was the most common symptom in the liver cysts. Phlegm (78.9%), Dyspnea (57.9%), acute (47.4%) and chronic cough (47.4%) were mostly seen in lung hydatid cysts. Some symptoms such as fever (68.4%) and weakness (59.6%) were the most common presenting symptoms in both groups. All children were treated through surgical approaches plus medical treatment. In the present report, liver was the most common site of involvement in children. Liver hydatidosis should be considered in children with upper quadrant pain and pulmonary hydatidosis in children complaining of phlegm and dyspnoea.