| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2001;71:2034-2035
© 2001 The Society of Thoracic Surgeons
a Department of Cardiology and Cardiac Surgery, Doce de Octubre Hospital, Madrid, Spain
Accepted for publication April 13, 2000.
Address reprint requests to Dr Tejada, Servicio de Cardiología, Hospital Doce de Octubre, Carretera de Andalucía Km 5.400, 28041 Madrid, Spain
e-mail: juliogtejada{at}yahoo.com
 |
Abstract |
|---|
 Top Abstract IntroductionCommentReferences |
|---|
|
Introduction |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
A 35-year-old man, without medical history, presented with urticarial exanthema, sweat, and intense itchiness 1 month before admission. During that month, he complained of evening fever and episodes of precordial pain which increased with deep breathing and postural changes (in lying position).
Physical examination revealed urticarial exanthema in both legs. A pericardial rub was heard at the left lower sternal border. A blood test showed an elevated erythrocyte sedimentation rate, eosinophilia, and normal liver and cardiac enzymes. Pericarditis was the initial diagnosis, and the patient was treated with aspirin (4 grams/day).
The chest x-ray film showed enlargement of the heart and deformation of the cardiac silhouette. The electrocardiogram revealed sinus rhythm, presence of Q-waves in leads V1–V3 and steep symmetrical T-wave inversion in leads II, III, aVF, V2–V6. Transthoracic echocardiography demonstrated a cystic mass (6 cm in diameter) having well-defined edges and internal trabeculations in distal interventricular septum that protruded inside the cavity of the left ventricle, as well as mild pericardial effusion. This mass was thought to be an echinococcal cyst, as this patient lived in an endemic area and had been exposed to dogs. Differential diagnosis included cystic degenerating tumors, pericardial cyst, myocardial abscess communicated with pericardium or pericardial hematoma. Magnetic resonance imaging confirmed the echocardiographic finding, showing small cystic structures corresponding to daughter membranes inside the liquid intramyocardial mass (Fig 1). Serologic test (agglutination) for Echinococcus granulosus was positive. Abdominal ultrasonography was normal.
|
|
|
Comment |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
Clinical features depend on size, number, location of the cysts and presence of complications. Presenting symptoms include anaphylactic reactions such as fever, eruptions, or even circulatory collapse. A frequent complaint is chest pain of pericardial origin, but it can also be of ischemic origin when displacement or obstruction of coronary artery branches occurs [5]. Other presenting forms include systemic hydatid embolism, tricuspid stenosis or regurgitation, and multiple hydatid pulmonary embolism causing severe pulmonary hypertension [4].
Diagnosis must be suspected when the patient lives in an endemic area and hydatid cysts are also present in other locations (55% of multivisceral involvement has been reported) [2]. The presence of eosinophilia in some patients is very useful complementary data. Chest x-ray film often shows abnormal shape of the heart shadow, or a sometimes calcified spherical mass. Diagnosis is made by using echocardiography and serologic tests (agglutination or complement-fixation), but excision and pathological examination of the lesion are required to confirm it.
Echocardiography is the imaging method of choice for diagnosis of cardiac cysts, even better than computed tomography or magnetic resonance imaging, which are more useful in the study of extracardiac echinococcosis [6]. In most patients, two-dimensional echocardiographic images of hydatidosis are cystic masses having well-defined edges and internal trabeculations corresponding to daughter vesicles. Some patients present solid masses, very difficult to differentiate from heart tumors, corresponding to cysts that have undergone a degenerative process. Rarely, cardiac echinococcosis shows a large multilocular mass with poorly defined edges [4].
Given the significant risk of cyst rupture, extirpation of the lesion is recommended, even in asymptomatic patients. Complete and rapid sterilization of the cyst content must be performed with the instillation of hypertonic saline solution or other agents. If total excision of the cyst wall is not feasible, the remaining cavity should be closed by obliteration, plication, or both. Operative mortality is low and the postoperative evolution is usually satisfactory, but it is not free of complications [2, 3]. The most frightful of them is rupture during surgical manipulation, with subsequent dissemination and liberation of the content to systemic circulation or pericardium, producing anaphylactic shock.
Serologic and echocardiographic controls are recommended for 5 years after extirpation to detect recurrences after surgical manipulation or cysts that were not discovered at operation [4].
|
References |
|---|
|
TopAbstractIntroductionCommentReferences |
|---|
Related Article
This article has been cited by other articles:
|
|
 |
|
  K. Gossios, G. Passas, D. Kontogiannis, and J. Kakadellis Mediastinal and Pericardial Hydatid Cysts: An Unusual Cause of Circulatory Collapse Am. J. Roentgenol., July 1, 2003; 181 (1): 285 - 286. [Full Text] [PDF]
|
|
|
|
 |
|
 H. Lahdhili, S. Hachicha, M. Ziadi, and H. Thameur Acute pulmonary embolism due to the rupture of a right ventricle hydatic cyst Eur. J. Cardiothorac. Surg., September 1, 2002; 22(3): 462 - 464. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
