Unusual Hydatid Cysts: Cardiac and Pelvic-Ilio femoral Hydatid Cyst Case Reports and Literature Review

Abstract

Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.

Incidental Asymptomatic Giant Hydatid Cyst of the Interventricular Septum Bulging Into the Right Ventricle

“…The echocardiographic appearance of a hydatid cyst may be confused with heart tumors. In this case, it is necessary to supplement with computed tomography or MRI which are effective in establishing a differential diagnosis between tumors and hydatid cysts [ 10 ]. In our case, the diagnosis was easy given the rich history of hydatid disease.…”

A huge right ventricular hydatid cyst related to tricuspid valve causing severe pulmonary hypertension

“…Left ventricular hydatid cysts grow as subepicardial masses, and rarely rupture in the pericardial space. 10 Gentle handling of the heart during cardiopulmonary bypass minimizes operative risk. All patients should be investigated for systemic cysts, 9 and this was done in our case.…”

“…They tend to expand inside the right ventricular cavity and in the subendocardial space, and are more prone to rupture which can lead to pulmonary embolism, anaphylaxis and sudden death. Left ventricular hydatid cysts grow as subepicardial masses, and rarely rupture in the pericardial space 10 . Gentle handling of the heart during cardiopulmonary bypass minimizes operative risk.…”

Isolated pericardial cystic Echinococcosis: A rare clinical presentation

“…rupture leading to tamponade, anaphylactic shock, systemic or pulmonary hydatid embolization, valve obstruction or regurgitation due to papillary muscle involvement, arrhythmia and atrioventricular conduction defect, pericarditis with pericardial effusion. [3][4][5] Early diagnosis and urgent treatment are needed even in asymptomatic individuals. Hydatid cyst should be considered in differential diagnosis for any intracardiac cystic mass.…”

“…1 Cardiac involvement by hydatid cysts presents only in 0.5-2% of cases of systemic echinococcosis. [3][4][5] Isolated pericardial cyst without myocardial involvement is very rare. High degree of suspicion is needed for cardiac cystic disease for early diagnosis.…”