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Isolated pericardial echinococcosis: Perioperative transesophageal echocardiographic evaluation
Neeti Dogra1, Goverdhan D Puri, Bhupesh Kumar
1Department of Anaesthesiology and Intensive Care, Advanced Cardiac Centre, PGIMER, Chandigarh 160 012, India.
Insights
Isolated pericardial hydatid cysts are rare cardiac parasitic infections. Transesophageal echocardiography (TEE) aids in diagnosing and evaluating these rare cardiac hydatid cysts, guiding surgical resection and albendazole therapy.
Area of Science:
- Cardiology
- Parasitology
- Medical Imaging
Background:
- Hydatid cyst (HC) is a parasitic disease caused by Echinococcus granulosus larvae.
- Cardiac involvement in HC is rare (0.5%-2%), with isolated pericardial HC being exceptionally rare.
- Pericardial hydatid cysts can present with symptoms like chest pain and dyspnea.
Purpose of the Study:
- To report two rare cases of isolated pericardial hydatid cyst.
- To highlight the diagnostic and evaluative role of transesophageal echocardiography (TEE) in cardiac HC.
- To emphasize the importance of surgical resection and medical therapy for pericardial HC.
Main Methods:
- Case presentation of two patients with isolated pericardial HC.
- Diagnostic workup included transthoracic echocardiography (TTE), CT/MRI, and hydatid serology.
- Intraoperative assessment using transesophageal echocardiography (TEE).
Main Results:
- Both patients presented with precordial chest pain and dyspnea.
- Diagnosis was confirmed by imaging and serology.
- TEE revealed distinct cystic lesions within the pericardial space.
- Surgical resection followed by albendazole therapy was successful in both cases.
Conclusions:
- Isolated pericardial hydatid cyst is an exceedingly rare condition.
- TEE is a valuable tool for the diagnosis and intraoperative evaluation of cardiac HC.
- A combination of surgical intervention and albendazole therapy is crucial for managing pericardial HC and preventing recurrence.
Abstract:
Hydatid cyst (HC) is a human parasitic disease caused by the larval stage of Echinococcus granulosus. Cardiac involvement is rare and occurs in 0.5%-2% of patients with hydatid cyst, but isolated pericardial hydatid cyst is rarer still. We present two cases of isolated pericardial hydatid cyst who presented with precordial chest pain and dyspnea. In both the cases, HC were diagnosed by transthoracic echo (TTE), Computed Tomography/Magnetic Resonance and positive hydatid serology. Intraoperatively transesophageal echo (TEE) revealed unilocular transitional cystic lesion the transverse pericardial sinus in one case and multilobulated active cystic lesion in another. The report highlights the role of TEE in diagnosis and evaluation of cardiac HC. Both the cases underwent surgical resection followed by albendazole therapy to prevent recurrence.
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