Sudden Death Due to an Unrecognized Cardiac Hydatid Cyst: Three Medicolegal Autopsy Cases

Abstract

Echinococcosis is a human infection caused by the larval stage of Echinococcocus granulosus. The most common sites of infection are the liver and the lungs. Cardiac hydatid cysts are very rare, even in regions where hydatic cysts are endemic (the Mediterranean, South America, Africa, and Australia). It has been reported that cardiac involvement is seen in about 0.5-3% of human echinococcosis cases. Three cases of cardiac hydatid disease that caused sudden death and which were histopathologically diagnosed are reported. Cardiac echinococcosis is rare, but due to its insidious presentation and affinity to cause sudden death, it is important that it be identified in the histopathological examination.

Sudden Death Due to Hydatid Disease: A Six‐Year Study in the Northern Part of Tunisia

“…The cysts will then grow slowly (1–5 cm a year) . After 3–6 years, the cysts can reach the size of a chicken egg . The symptoms of hydatid disease are very wide and nonspecific, it depends on the location and the size of the cyst .…”

“…Heart hydatid cyst represents 1-3% (1,5). Other authors who reported cases of death due to heart hydtatid cyst described different mechanisms of death: anaphylaxis and/or embolization by cyst daughter complicating cyst rupture, fatal arrhythmia, pumping obturation, myocardial infarction by coronary artery obstruction, tamponade, pericarditis or pulmonary hypertension (7,8,16,24,33,34).…”

“…KEYWORDS: forensic science, forensic pathology, hydatidosis, echinococcosis, sudden death, anaphylaxis, autopsy Human ecchinococcosis also known as hydatid disease is a zoonotic infection caused by the tapeworm Ecchinococcus (E.). Human infection is frequently caused by Ecchinococcus granulosus, responsible for 95% of the 2-3 Million global cases worldwide mainly in the Mediterranean both costs and Middle East countries, Great Britain, Southern Africa, Australia, New Zeland and South America (1,2) followed by E. multilocuralis which causes cystic and alveolar Ecchinocosis, respectively (1)(2)(3)(4)(5)(6)(7)(8)(9). It is a widespread disease, endemic in rural areas where sheep raising is a common activity, and therefore, a close contact between humans and sheep is established (1,3,5,10).…”

Left ventricle hydatid cyst mimicking acute coronary syndrome

“…Cardiac echinococcosis is rare but may result in serious complications such as pericardial tamponade [1], pulmonary embolism [8] and, moreover, may cause sudden death [9]. Rarely, similar to the present case, it may mimic ACS, for which treatment is completely different.…”

Surgical Approach to the Management of Cardiovascular Echinococcosis

“…Rapid histopathologic evolution of this material is a valuable diagnostic criterion to determine a ruptured cardiac hydatid cyst. Briefly, clinical presentations are directly associated with location, size, and integrity of the cysts and may vary from asymptomatic to sudden death 17 . Yaliniz et al 5 reported seven cases with nonspecific symptoms.…”