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Ann Thorac Surg 2001;71:2035-2036
© 2001 The Society of Thoracic Surgeons

Case report: invited commentary

Invited commentary

Lorenzo Fernandez Fau, MDa

a Thoracic Surgery Unit, Hospital Universitario de la Princesa, c/Diego de Leon 62, 28006 Madrid, Spain

e-mail: lffau{at}separ.es

Thoracic hydatic disease is relatively common in areas in which the parasitic infestation due to Echinococcus granulosus is endemic. However, extrapulmonary chest involvement is uncommon. The number of reported cases of hydatic cysts affecting the mediastinum is slightly over 100. Cardiac hydatic cysts are also rare. Tejada and colleagues report a case of a patient with a hydatic cyst in the heart who was adequately diagnosed and successfully treated. In general, the size of the cyst depends on the length of time of infection and the resistance of the surrounding tissues. The presence of daughter cysts in the lung occurs in less than 1%, but they are more commonly seen in cases of extrapulmonary chest involvement. The case presented by Tejada and associates has some exceptional features related to its location, diameter, associated hemopericardium, and the presence of daughter cysts.

Surgical resection is the best treatment for hydatic cysts. The capitonage of the adventicia is indicated when complete extraction cannot be performed safely, when there are small bronchial communications, or when the cardiac walls have been weakened by excessive growth of the cyst. Secondary hydatidosis produced by the systemic dissemination of the cyst contents can be a serious complication of the surgical approach. Direct sterilization on the cyst, and the pre- and postoperative administration of antiparasitic drugs is a common practice to avoid recurrences. However, the efficacy of this strategy is controversial. Albendazole, a benzimidazole derivative, is the most commonly used drug. It is indicated in unresectable cases, and in cases of spontaneous or iatrogenic ruptures, as prophylaxis.


Related Article

Hydatid disease of the interventricular septum causing pericardial effusion
Julio G. Tejada, Jesus Saavedra, Luis Molina, Alberto Forteza, and Casimiro Gomez
Ann. Thorac. Surg. 2001 71: 2034-2035. [Abstract] [Full Text] [PDF]




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