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Acute limb ischemia caused by ruptured cardiac hydatid cyst - A case report
Samer Makki Mohamed Al-Hakkak1, Firas Shaker Mahmoud Al-Faham2, Ali Najeh Al-Awwady1
1Department of Surgery, Faculty of Medicine, Jabir Ibn Hayyan Medical University, Najaf City, Iraq.
Insights
A ruptured cardiac hydatid cyst (CHC) can cause acute limb ischemia by embolizing daughter cysts. This rare condition should be considered in young patients presenting with sudden limb ischemia in endemic areas.
Area of Science:
- Cardiology
- Parasitology
- Vascular Surgery
Background:
- Acute limb ischemia is a critical condition threatening limb viability, often caused by arterial occlusion.
- Cardiac hydatid cyst (CHC) is a rare cause of cardiac disease, with potential for life-threatening complications including arterial embolism.
- Rupture of a CHC can lead to peripheral arterial embolism, presenting as acute lower limb ischemia.
Purpose of the Study:
- To report a case of acute lower limb ischemia secondary to a ruptured cardiac hydatid cyst.
- To highlight the importance of considering CHC in the differential diagnosis of acute limb ischemia in endemic regions.
Main Methods:
- Case report of an 18-year-old male presenting with acute right lower limb ischemia.
- Diagnosis and emergency surgical management of a ruptured primary cardiac hydatid cyst.
Main Results:
- The patient presented with sudden onset acute right lower limb pain and paresthesia.
- The cause was identified as embolization of daughter cysts from a ruptured CHC into the right external iliac artery, leading to acute limb ischemia.
Conclusions:
- The clinical presentation of ruptured CHC depends on cyst location and daughter cyst migration.
- Cardiac hydatidosis must be considered in young individuals with sudden acute limb ischemia, especially in hydatidosis-endemic regions, even without prior cardiac history or trauma.
Introduction:
Acute limb ischemia is a sudden decrease in limb perfusion that threatens the viability of the limb. Complete or even partial occlusion of the arterial supply to a limb can lead to rapid ischemia and poor functional outcomes within hours. In human echinococcosis cardiac involvement is a rare presentation, it may lead to life-threatening complications including cyst rupture; anaphylactic shock; tamponade; pulmonary, cerebral or peripheral arterial embolism. Cardiac hydatid cyst (CHC) may have different presentation include acute lower limb ischemia secondary to embolization from a ruptured cyst.
Case Presentation:
We report an 18-year old male healthy building worker while he was working who presented with sudden onset acute right lower limb pain and paresthesia caused by rupture of primary CHC which managed as a surgical emergency.
Discussion:
Clinical presentation of ruptured of CHC depends on the specific location of the ruptured cyst that interferes and mobilization of daughter cyst that logged in vascular system with the function of the surrounding cardiac structures like our case that present with embolization of daughter cyst into the right external iliac artery which leads to acute limb ischemia.
Conclusion:
Cardiac hydatid cyst is a rare finding with a wide range of signs and symptoms. We are reporting this case to underline that cardiac hydatidosis should be considered as a differential diagnosis in young patients who suddenly develop acute limb ischaemic without a history of both cardiac diseases and trauma that lives in endemic regions of hydatidosis.
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