Cardiac recurrent hydatid cyst of the right ventricle: case report

Abstract

Background. Hydatid disease is a parasitic infection caused by larvae of Echinococcus granulosus. Hydatid cysts can be located in various tissues, although they are most common in the liver and the lungs. Cardiac involvement is scarcely encountered with a frequency of 0.01% to 2. Areas of cardiac involvement in hydatid disease including the left ventricle (60% of cases), right ventricle (10%), pericardium (7%), pulmonary artery (6%), and left atrial appendage (6%); involvement of the interventricular septum is rare (4% of cases). Right ventricular cysts have characteristics different from those of left-sided cysts. Right-sided cysts have a tendency to expand intracavitarily and subendocardially, and rupture more frequently, and can cause fatal complications such as anaphylactic shock, dissemination, and pulmonary embolisms.Case report. We present the case of 58 years asymptomatic old man with cardiac cyst. His past history revealed surgery for a cardiac hydatid cyst 22 years previously, embedded in the right ventricular myocardium. The cyst was resected, during the operation, rupture of the cyst was noted. He completed lasting courses of albendazole therapy. During a 22 years follow-up, the patient was asymptomatic, with no cystic appearance on transthoracic echocardiography, but was observed pulmonary dissemination over a period. This time, at the routine examination, through transthoracic echocardiography was performed and revealed in the apical region of right ventricle, in the free wall, a multicameral cystic formation with d- 31 x 23 mm suggestive for hydatid cyst. Further investigation was performed with cardiac magnetic resonance imaging (MRI), which showed a conglomerate of hydatiC cysts of the lateral apical myocardium of the right ventricle (measured 27 x 23 mm), with protrusion into the cavity of the right ventricle and into the cavity of the pericardium and nodular lesions of pulmonary areas suspected for hydatic lesions. Chest X-ray revealed bilateral nodular opacities of different dimensions. A coronary angiogram showed severe stenosis on LAD II-III, DP, insignificant on RCA II, III . The patient was recommended to repeat cardiac surgery with by-pass, and pulmonary CT for provide an accurate diagnosis. Conclusions. According to the literature, cardiac cystic echinococcosis remains a very infrequent zoonotic infection. Surgical treatment is associated with a low morbidity and mortality, and the selection of proper technique is very important to completely remove the hydatid cyst and prevent recurrence. A superadded infection is the most common complication of a ruptured hydatid cyst. The risk of recurrence is present; the recurrence may appear much later hence the importance of echocardiographic and radiological monitoring.