Asian Cardiovasc Thorac Ann 2000;8:275-277
© 2000 Asia Publishing EXchange Pte Ltd
Hydatid Cyst on Right Ventricular Posterior Wall
Kadir Durgut, MD,
Ufuk Özergin, MD,
Kurtulu
Özdemir, MD1,,
Niyazi Görmü, MD,
Tahir Yüksek, MD,
Hasan Solak, MD
Department of Cardiovascular Surgery
1 Department of Cardiology
University of Selçuk
Konya, Turkey
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For reprint information contact: Kadir Durgut, MD Tel: 90 332 323 2600 Fax: 90 332 323 2643 email: kdurgut{at}selcuk.edu.tr Department of Cardiovascular Surgery, University of Selçuk, Konya 42080, Turkey.
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Abstract
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A 14-year-old boy was investigated for unexplained tachycardia and multiple pulmonary emboli demonstrated by computed tomography. A right ventricular hydatid cyst was diagnosed by echocardiography and successfully excised under cardiopulmonary bypass.
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Introduction
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Hydatidosis is still an important health problem in our country.1 The disease is frequently seen in the liver (65%) and lungs (25%) but rarely in other organs. Cardiac involvement is seldom reported.1–5 A case is described of hydatid cyst located in the right ventricle, causing multiple pulmonary emboli.
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Case Report
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A 14-year-old boy was admitted to the pneumology clinic with a 2-week history of progressive headache, fatigue, anorexia, lateral chest and back pain, cough, weight loss, and dyspnea. His arterial pressure was 110/80 mm Hg, heart rate 100 beats•minute–1, and his lips were mildly cyanotic. Breathing sounds were decreased in the right posterior basal region. Bilateral micro-lymphadenopathy was present in the submandibular, supraclavicular, axillary, and inguinal regions. The erythrocyte sedimentation rate was 86 mm•h–1 and eosinophilia was detected; other laboratory tests were normal. Chest radiography showed bilateral hilar enlargement, a blunted right angle, and nonhomogenous infiltration in the right lower zone. Computed tomography of the thorax revealed aneurysmal dilatation of the pulmonary arteries and multinodular embolic images (Figure 1
). Pulmonary perfusion scintigraphy showed a defect in the posterior segment of the right upper lobe (Figure 2). The patient was diagnosed with periarteritis nodosa and treated with heparin, broad-spectrum antibiotics, and corticosteroid.
His unexplained tachycardia continued. On echocardio-graphy, a nonhomogenous mass measuring 3 x 4 cm was observed in the right ventricle (Figure 3). Consequently, he was admitted to our clinic with suspicion of myxoma or cardiac hydatid cyst. Surgery was carried out under cardiopulmonary bypass with antegrade crystalloid cardioplegia. The tricuspid valve was retracted via a right atrial incision. A 3 x 3 x 4-cm hydatid cyst was found attached to the posterior wall of the right ventricle, which had grown into the ventricular cavity and ruptured. The cysts and the pericystic pouch were excised. No peri-operative complications occurred. The multiple lesions in the lungs were attributed to cystic embolization. Therefore, anthelmintic treatment (albendazole, 15 mg•kg–1) was given. The postoperative echocardiogram is shown in Figure 4. The patient was discharged from the hospital in good condition on the 10th postoperative day and he was found to be well at follow-up 15 months later.
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Figure 3. Two-dimensional echocardiogram showing a nonhomogenous mass in the right ventricular cavity.
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Discussion
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Cardiac involvement in hydatidosis has been reported with a frequency in the range of 0.2% to 3%.1–5 Cardiac hydatid cysts are more often seen in the left ventricle, presumably because blood flow is higher than in the right ventricle.2–5 Signs and symptoms of such cysts are due to their location, growth, and rupture. Disturbances of valvular function, ischemic events, and conduction anomalies may be caused by cystic pressure. If a cyst ruptures into the left heart, peripheral and cerebral embolization may occur. If it ruptures into the right heart, pulmonary emboli may be seen. Pericarditis with effusion, immunologic reactions, and cardiac tamponade may develop when the cyst ruptures into the pericardial space. Cough, pleural chest pain, hemoptysis, and fever may result when a cyst ruptures into the right heart, as seen in this patient.
Latex agglutination and immunoelectrophoresis are the most useful tests. The Casoni and Weinberg tests and analysis of eosinophilia on peripheral smears are less sensitive.1 Electrocardiography and chest radiography are not specific. Echocardiography is the most sensitive method of diagnosing cardiac hydatid cyst and it is preferred because it is noninvasive. Computed tomography and magnetic resonance imaging may be performed if needed. Angiography and heart catheterization may provide important information but the catheter might rupture the cyst. Consequently, it should not be performed unless clearly indicated.
Cardiac hydatid cysts should be treated by surgical excision under cardiopulmonary bypass. The operative risk is low. It has been suggested that anthelmintics (mebendazole or albendazole) should be given in the postoperative period because of the risks of vesicular implantation and embolization.1–4 Although cardiac involvement of hydatid disease is rare even in endemic areas, this case study suggests that echocardiographic evaluation should be performed in patients with hydatid cysts elsewhere in the body.
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References
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Miralles A, Bracemonte Y, 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]
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Solak H, Yüksek T, Yeniterzi M, Akkoç Ö, An
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Yekeler I, Koçak H, Aydin NE, Basoglu A, Okur A, Senocak H, et al. A case of cardiac hydatid cyst localized in the lungs bilaterally and on anterior wall of right ventricle. Thorac Cardiovasc Surg 1993;41:261–3.[Medline]
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Pasaoglu I, Dogan R, Hazan E, Oram A, Bozer AY. Right ventricular hydatid cyst causing recurrent pulmonary emboli. Eur J Cardio-thorac Surg 1992;6:161–3.[Abstract]
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Byard RW, Bourne AJ. Cardiac echinococcosis with fatal intracerebral embolism. Arch Dis Child 1991;66:155–6.[Abstract/Free Full Text]
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Abstract
Introduction
