Left ventricle hydatid cyst

Clinical History

A 22-year-old female patient presented with right upper quadrant pain and chest pain. Her past medical history was unremarkable.

Imaging Findings

On CT, a thick-walled cystic lesion was noted within the lumen of the left ventricle with contact to the interventricular septum (Fig. 1, 2). In addition, a large thick-walled cystic lesion was seen in the lower lobe of the left lung (Fig. 1, 2). Multiple thick-walled cystic lesions were seen in the liver (Fig. 2, 3). All cysts were hyopodense and did not show any calcifications.
Based on the imaging findings, hydatid disease was suspected.

Discussion

The first case of cardiac hydatidosis was reported by Williams in 1836 [3]. The prevalence of cardiac hydatidosis is very low, accounting for only 0.5 to 2% of hydatid disease [1, 2].
Cardiac involvement is believed to occur through coronary artery circulation, pulmonary veins or by direct contact with hydatid cysts originating from the liver or the lung.
The left ventricle is the most common site (50-60%) due to the thickness of the myocardium, followed by the right ventricle (15%), the interventricular septum (9%), left atrium (8%), right atrium (4%) and interatrial septum (2%) [2].
Hydatid cyst fluid is a very potent anaphylactic substance. If a hydatid cyst ruptures into the cavity of the heart, the cyst fluid may cause anaphylaxis and the cyst membrane may cause an embolus. Rupture into the pericardial cavity may lead to pericarditis, effusion, or cardiac tamponade [2].
Most patients with cardiac hydatidosis have no symptoms because hydatid cysts grow very slowly. Clinical presentations are extremely variable and directly related to the location and size of the cysts. Only approximately 10% of patients, especially those with large hydatid cysts, have clinical manifestations. Vague pericardial pain is the most common presenting symptom [1].
The diagnosis of cardiac echinococcosis is mainly based on the combination of clinical suspicion, cardiac imaging and serologic tests [4]. Echocardiography, CT and MRI can show the cystic nature of the mass and its relation to the cardiac chamber. CT best shows wall calcification [1].
Echocardiography is a highly sensitive and specific tool for the diagnosis of cardiac hydatid disease and shows the effect of the lesion on ventricularorvalvular functions [4].
On MR imaging, hydatid cysts usually appear as oval-shaped lesions, which are hypointense on T1 weighted images and hyperintense on T2 weighted images. The cysts may be single or multiple, uniloculated or multiloculated and thin or thick-walled [1].
Surgery is the treatment of choice in cardiac hydatidosis, although antihelminthic drugs have been used in the preoperative and postoperative periods since 1977 [1]. To prevent complications, open heart surgery with cardiopulmonary bypass and systemic arterial clamping is performed to prevent dissemination in case of cyst rupture.

Differential Diagnosis List

Final Diagnosis

Left ventricle hydatid cyst

URL:	https://www.eurorad.org/case/13100
DOI:	10.1594/EURORAD/CASE.13100
ISSN:	1563-4086