Cardiac and Hepatic Hydatid Cyst Interesting Case Report

Rudolasano R and Yoradalov YP

Published on: 2024-02-03

Abstract

Infection with Echinococcus granulosus is the most common form of echinococcal infection in humans Hydatid disease is a zoonosis parasitic infection caused by Echinococuse granulosus, E. multilocularis, or E. vogeli. Dogs and cats are primary carriers of this parasite.

Human can be infected as an intermediary carrier when eat unwashed or uncooked vegetables or swallow the parasite eggs. Embryo of the parasite inserts into blood circulation from intestine and can involve every organ [1]. This infection commonly involves liver through portal vein, but if embryos bypass the liver, they reach the lungs via the inferior vena cava. They can also involve other organs like heart. The frequency of cardiac involvement is lesser than 2%.

A very rare case of echinococcus cysts of the heart and brain Cardiac hydatid cysts present as diagnostic dilemma and therapeutic challenge to the cardiologists. It results from infestation with the larval or adult form of Echinococcus granulosus. Isolated cardiac involvement is rarely seen.

Keywords

Echinococcus; Granulosus; Cardiac

Introduction

Hydatid disease is a zoonotic parasitic infection caused by Echinococuse granulosus, E. multilocularis, or E. vogeli. Dogs and cats are the main carriers of this parasite. Humans can be infected by eating unwashed or undercooked vegetables or by ingesting the parasite's eggs. The parasite embryo is introduced into the bloodstream from the intestine and can involve any organ [1]. This infection usually affects the liver via the portal vein, but if the embryos bypass the liver, they reach the lungs via the inferior vena cava. They can also involve other organs such as the heart. The incidence of cardiac involvement is less than 2% [2,3]. Intracardiac tumors, congenital cysts, and aneurysms are in the differential diagnosis of this lesion [4,5]. The left ventricle is the most common site of cardiac involvement [1].

The diagnosis of cardiac hydatid disease is based on a combination of clinical suspicion, serological tests, and cardiac imaging. Echocardiography is highly sensitive and specific for the diagnosis of hydatid cysts [6], and positive serological tests can help to diagnose this disease.

Here, we present a rare case of hydatid cyst with cardiac involvement and discuss the important points about the disease.

Purpose

Presentation of data and early postoperative results in a patient with a very rare case of echinococcal cysts of the heart and liver, operated on at the Clinic of Hepatobiliary, Pancreatic and General Surgery of "Tokuda Hospital Sofia" AD and analysis of the information obtained.

Material and Method

In the Clinic of Hepatobiliary, Pancreatic and General Surgery of "Tokuda Hospital Sofia" AD, a 38-year-old woman with an echinococcal cyst of the liver was operated on. Previous surgical interventions - extirpation of an echinococcal cyst from the left ventricle of the heart.

Methods

Diagnostic - Anamnestic data (incl. from accompanying documentation), clinical picture, instrumental diagnostics (MRI of the pelvis, laboratory diagnostics;
Surgical methods - Resecto hepatis laparoscopica;
Follow-up in the early postoperative period

Clinical Case Presentation

A 38-year-old woman, admitted due to heaviness and discomfort in the right hypochondrium. Past illnesses: Condition after PAIR-devitalization of an echinococcal cyst (2013). Condition after extirpation of an echinococcal cyst from the left ventricle of the heart (2014). Ultrasound, MRI, ELISA were performed. Surgical intervention-laparoscopic cyst resection was performed (Figure 1).

Figure 1: Surgical intervention-laparoscopic cyst resection was performed.

Discussion

Cardiac hydatid cyst is a rare disease, and symptoms depend on the size and location of the infection. Hydatid cyst growth is usually slow and asymptomatic, and only about 10% of patients with cardiac hydatid cysts are symptomatic [6]. Without prompt surgical treatment, rupture of the cyst or compression of vital structures may occur. As we found in our patient, hydatid cysts most commonly affect the left ventricle (55–60%), as this chamber of the heart has the greatest myocardial mass and blood supply [7]. Hydatid cysts involving the left ventricle may mimic left ventricular aneurysms and should be considered in the differential diagnosis of cystic cardiac lesions in endemic areas [6]. Other parts of the heart may also be involved (Figures 2, 3).

Figure 2: Hydatid cysts involving the left ventricle may mimic left ventricular aneurysms.

Figure 3: Cardiac contractions provide a natural resistance to a viable hydatid cyst.

Structures such as the interventricular septum are involved in 5%-9%, the right ventricle in 15%, and the right atrium may be involved in 3%-4% of cases [7-9]. Cardiac contractions provide a natural resistance to a viable hydatid cyst, but this mechanism is not effective in all cases, and the parasite may invade myocardial tissue in rare cases [10]. Initially, the cyst grows slowly between the cardiac fibers and causes no signs or symptoms. Later, it may cause pericardial pain, dyspnea, invade surrounding structures, obstruct blood flow, and also invade the cardiac conduction system and cause cardiac arrhythmias [2,6]. Some cases may mimic acute coronary syndrome [3]. The most important major complication is cyst rupture, which can cause anaphylactic shock or tamponade, systemic or pulmonary embolism, and coronary artery compression [7].

Echocardiography is essential for the diagnosis of cardiac hydatid cyst. However, CT or MRI is required to obtain additional information about the exact location of the lesion and its relationship to other structures [6]. The presence of calcification in a cystic lesion on echocardiography and MRI may be useful in distinguishing it from other cardiac cystic lesions [4,6]. Other useful findings on MRI include the presence of daughter cysts and membrane detachment [1].

Conclusion

Early diagnosis and surgical-medical treatment is the key to the successful treatment of cardiac hydatid disease. In endemic areas, hydatid cyst should be considered in the differential diagnosis of heterogeneous echogenic lesions, even if serological tests are negative. Combination with hepatic intervention and removal of cysts in other organs ensures the successful course of the disease.

International Journal of Surgery and Clinical Practice