Cardiac hydatid cysts are found in fewer than 2% of cases of hydatidosis. 1–3 However, in more than 50% of such cardiac cases, there is multiorgan involvement. 2 The larvae reach the myocardium through the coronary circulation. 1,2,4,5 Multiple cardiac hydatid cysts are rare; most occur singly. 1–3
A 16-year-old adolescent boy presented at our institution with respiratory distress and weight loss (about 18 lb within 2 months). Computed tomographic scanning of the chest revealed 2 large cysts occupying the upper fields of both lungs (Fig. 1). These findings raised the possibility of smaller cysts in the heart. Two-dimensional echocardiography showed multiple cardiac hydatid cysts that were situated superficially in the left and right ventricular myocardial walls (Fig. 2). The pulmonary and cardiac cysts were removed in a single stage, through a transverse sternotomy incision, without cardiopulmonary bypass. Surgical findings confirmed the accuracy of the preoperative echocardiographic image (Figs. 2 and 3).
Fig. 1 Computed tomographic scan of the chest shows large hydatid cysts in the upper fields of both lungs.
Fig. 2 Echocardiographic view reveals multiple hydatid cysts siuated superficially in both ventricles.
LV = left ventricle; RV = right ventricle
Fig. 3 Intraoperative photo shows multiple hydatid cysts (arrows) in the right and left ventricular walls.
Echocardiography is the imaging method of choice for studying cardiac and pericardial hydatidosis. 1,2,4,5 The classic echolucent liquid-filled image of the cyst, either plain or multivesicular, is observed in about half of cases. 5 In most instances, the safety of surgical treatment for cardiac hydatid cysts can be determined on the basis of echocardiographic findings. 4,5 In addition, echocardiography is very helpful in planning the operation: providing accurate information about the location of the cardiac cysts and helping to determine whether cardiopulmonary bypass is necessary. 1,4,5
Footnotes
Address for reprints: John N. Kokotsakis, MD, 12 Grigoriou Afxendiou, Kifissia, Athens, Greece 14562
References
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