Asian Cardiovasc Thorac Ann 2006;14:e43-e44
© 2006 Asia Publishing EXchange Ltd
Hydatid Cyst of the Right Atrium: A Rare Presentation
Shekhar Tandon, MCh,
Anshuman Darbari, MS
Department of Cardiothoracic and Vascular Surgery, King George’s Medical University, Lucknow, India
For reprint information contact: Shekhar Tandon, MCh Tel: 91 522 239 1919 Fax: 91 522 225 5394 Email: darbaril{at}indiatimes.com, Department of Cardiothoracic and Vascular Surgery, K.G. Medical University, Lucknow, India.
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ABSTRACT
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Hydatid cyst of the heart is an uncommon lesion. Reported is the case of a 24-year-old female patient admitted with a history of chest pain and hemoptysis, and a mass lesion in the right atrium. Investigations and intraoperative intervention revealed the mass to be a hydatid cyst located in the right atrium, along with hydatid cysts of the liver and both lungs. The right atrial mass was successfully removed under cardiopulmonary bypass.
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INTRODUCTION
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The most frequent locations of hydatid cysts in humans are in the liver (65%) and the lungs (25%), with only 0.5% to 2% of cases located in the heart.1,2 The life cycle of this cestode/tapeworm involves dogs and other canids as definitive hosts, and domestic or wild ungulates, usually sheep, as intermediate hosts. Human beings are only incidental intermediate hosts of this parasite. Consequently, the infection is most common in sheep rearing areas of the world.
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CASE REPORT
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A 24-year-old female patient presented with complaints of palpitations, chest pain, and breathlessness which she had suffered for the previous 5 years, in addition to a single episode of hemoptysis that had occurred 2 months previously. Chest examination was unremarkable, but abdominal examination revealed mild tender hepatomegaly. Chest radiography revealed a rounded opacity in the upper zone of the right lung and another opacity in the left mid zone. Computed tomography (CT) scan demonstrated multiple pulmonary coin masses, right hilar lymphadenopathy and a multiseptate mass in the right atrium (Figure 1
) along with multi-cystic lesions in the liver. Two-dimensional echocardiography showed a multi-cystic right atrial mass measuring 4.5 x 3.3 cm attached to the interatrial septum, partially obstructing the inferior vena cava. Enzyme-linked immunosorbent assay test (ELISA) with IgG and indirect hemagglutination test for echinococcosis, proved positive. Treatment proceeded with a three week course of albendazole (400 mg), twice daily. In addition, due to obstruction of the inferior vena cava by the right atrial mass and a history of hemoptysis, surgical intervention was planned.
Surgery was performed via a median sternotomy and cardiopulmonary bypass was achieved by cannulation of the aortic and superior vena cava. Right femoral vein cannulation was performed to overcome the obstruction of the inferior vena cava. Electrical fibrillation was induced, and the right atrium opened under mild hypothermia. A multi-cystic mass was observed lying low in the right atrium, attached to the interatrial septum. Sterilization of the cysts was performed by instillation of hypertonic saline solution and the cysts were enucleated. Similarly, cysts from both lungs were also removed following sterilization, but no action was taken on the multiple small cysts found in the liver. Pathological and microbiological examination of the surgical material confirmed the presence of hydatid cysts. No postoperative complications were encountered and the patient was discharged on the 7th postoperative day, on albendazole 400mg, twice daily. On follow-up, the patient had fully recovered.
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DISCUSSION
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Cardiac involvement of hydatid cyst is an uncommon lesion as compared with hepatic or pulmonary hydatidosis, with a reported prevalence of only about 0.5% to 2%.1,2,8 The most common location of cardiac hydatid cysts is the left ventricle, followed by the interventricular septum and the right ventricle, whereas hydatid cysts in the pericardium, right atrium or left atrium are very rare.1 Indeed, Miralles and colleagues reported nine cases of hydatid cyst of the heart, in which only one patient was diagnosed as having right atrial alveolar hydatid disease.3 Only two previous cases of isolated cardiac echinococcosis have been reported in the form of hydatid cyst of the interventricular septum and pericardial hydatid cyst.4,5
Patients with cardiac hydatid cysts are usually asymptomatic, although mild, recurrent, nonspecific chest pain is the most common complaint. This may be due to episodes of partial rupture into the pericardium, with resultant pericarditis, or as a result of external compression of the coronary artery.5 The clinical presentation varies depending on the location, size, and integrity of the cardiac cysts. Patients may present with other symptoms due to mechanical interference with cardiac function, simulating coronary artery disease, arrhythmias, conduction disturbances, pericarditis, and peripheral emboli or as an abnormality of the cardiac silhouette on chest X-Ray.8 Serological diagnoses of cardiac hydatid cyst are unreliable, since despite high specificity, the sensitivity in intact cysts is low.6 Two-dimensional echocardiography is thus currently the best diagnostic procedure to demonstrate a cardiac hydatid cyst, with magnetic resonance imaging (MRI) being used more recently to diagnose hydatid cysts.5,7,8 Surgical excision remains the treatment of choice for cardiac hydatid cyst, with adjuvant oral albendazole therapy to reduce the size of the cyst and prevent recurrence.2,8
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REFERENCES
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- Dighiero J, Canabal EJ, Aguirre CV, Hazan J, Horjales JO. Echinococcus disease of the heart. Circulation 1958;17:127–32.[Abstract/Free Full Text]
- Heyat J, Mokhtari H, Hajaliloo J, Shakibi G. Surgical treatment of echinococcal cyst of the heart. Report of a case and review of the world literature. J Thorac Cardiovasc Surg 1971;61:755–64.[Medline]
- Miralles A, Bracamonte L, Pavie A, Bors V, Rabago G, Gandjbakhch I, et al. Cardiac echinococcosis. Surgical treatment and results. J Thorac Cardiovasc Surg 1994;107:184–90.[Abstract/Free Full Text]
- Aupetit JF, Ritz B, Ferrini M, Coppin M, Champsaur G. Images in cardiovascular medicine. Hydatid cyst of the interventricular septum. Circulation 1997;95:2325–6.[Free Full Text]
- Gulati G, Goyal NK, Kothari SS, Sharma S, Bisoi AK. Pericardial hydatid cyst. Indian Heart J 2002;54:437–8.[Medline]
- Onursal E, Elmaci TT, Tireli E, Dindar A, Atilgan D, Ozcan M. Surgical treatment of cardiac echinococcosis: report of eight cases. Surg Today 2001;31:325–30.[Medline]
- Oliver JM, Sotillo JF, Dominguez FJ, Lopez de Sa E, Calvo L, Salvador A, et al. Two-dimensional echocardiographic features of echinococcosis of the heart and great blood vessels. Clinical and surgical implications. Circulation 1988;78:327–37.[Abstract/Free Full Text]
- Akar R, Eryilmaz S, Yazicioglu L, Eren NT, Durdu S, Uysalel A, et al. Surgery for cardiac hydatid disease: an Anatolian experience. Anadolu Kardiyol Derg 2003;3:238–44.[Medline]
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ABSTRACT
INTRODUCTION
