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Heart echinococcus cyst as an incidental finding: early detection might be life-saving
© Tsigkas et al; licensee BioMed Central Ltd. 2010
Received: 4 October 2010
Accepted: 8 December 2010
Published: 8 December 2010
We present a 46-year-old female smoker who was admitted to the emergency department of our hospital due to cough with blood-tinged sputum for the last four days before admission. Using echocardiography and Multi-Detector Computed Tomography (MDCT) heart Echinococcosis was diagnosed. Echinococcosis is a severe health issue in some geographical regions of the world. Hydatid infection of the heart is rare and the clinical presentation is usually insidious but there is always the lethal hazard of cyst perforation. Early diagnosis and an integrated treatment strategy are crucial. The results of surgical treatment of heart echinococcosis are better than the conservative strategy only. Extraction of the cyst combined with chemotherapy peri or post operative aiming to decrease the recurrences, consists the lege artis method of encountering this medical entity. Surgical excision was performed and the patient had an uneventful recovery and follow up at six and twelve months.
Hydatid disease is a common health problem in Mediterranean and especially in sheep-farming countries, caused by infection with the metacestode stage of the tapeworm Echinococcus. The liver is the most frequent primary site of Echinococcus granulosus infection in humans. Cardiac involvement is rare, and early diagnosis and prompt surgical intervention are critical, with complete resection of the germinal layer being of major importance for recurrence avoidance. Perioperative administration of albendazole has been reported to improve surgical outcome.
Echinococcosis was firstly described in the works of Hippocrates in the 4th century AD. Echinococcus granulosus is a cosmopolitan parasite. The overall incidence of Echinococcus infection is 0.4 per 100,000 persons. Humans are an accidental intermediary host, although most often found in the liver (60-70%) and lung (20-30%), hydatid cysts can occur in any organ or tissue. Involvement of the heart can occur from the systemic or pulmonary circulation or as direct extension from adjacent structures . Isolated cardiac involvement is rare and occurs in only 0.02-2% of cases . It can be located at any part of the heart and the manifestations depend on the size, location, and integrity of the cyst. The left ventricle myocardium is involved 2-3-fold more frequently than the right one with fewer cases at interventricular septum. Involvement of left and right atrium is approximately equal . Pericardial cysts occur mostly in multifocal heart echinococcosis. Solitary pericardial cysts are rare . Although the serologic reactions for hydatid cyst provide essential information, their sensitivity is not high and parameters frequently do not correspond to the morphological changes of the disease . Transthoracic echocardiography and more recently, contrast echocardiography, computed tomography, and magnetic resonance imaging are the most important tools for diagnosis and follow up of the patient.
Cyst perforation is the most hazardous complication of heart echinococcosis. As a rule, left ventricle cysts perforate out of the cavity (10 to 20 times more frequently than right ventricle cysts), and right ventricle cysts perforate into it [7, 8]. The frequency of intracardiac perforation is very high (25-40%). After cyst perforation 75% of the patients died from septic shock or embolic complications [9, 10].
Whereas cysts in other organs may be treated both by chemotherapy and surgical manipulations, in the case of heart echinococcosis it is impossible to administer antihelmintic medicines prior to surgery due to the risk of cyst wall destruction and rupture. In addition the results of surgical treatment of heart echinococcosis are better than the conservative strategy only . On the other hand, there have been described major surgical implications from rupture, with systemic or pulmonary embolization, pericardial dissemination, purulent inflammation, and sepsis [12, 13].
In view of the difficulties of the diagnosis and the progressive and dangerous complications in its natural course, surgical treatment of cardiac echinococcosis is urgent [14, 15]. In conclusion, the treatment of heart echinococcosis should be a combination of surgical intervention with chemotherapy during or post-operative period aiming to decrease the recurrences.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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