Synchronous cardiac and hepatic echinococcosis in a pediatric patient: a case report

Hydatidosis caused by Echinococcus granulosus rarely involves the heart (0.5-2%), posing risks of rupture, tamponade, or anaphylaxis. Synchronous cardiac and hepatic disease is exceptionally uncommon in children.

An 8-year-old Arab male presented with abdominal pain, vomiting, fever, and dry cough; there was no prior instability or arrhythmia. Imaging revealed multiple calcified hepatic cysts and a subepicardial cyst compressing the left ventricle (with no coronary involvement). After administration of albendazole (15 mg/kg/day for 2 weeks preoperatively), a staged approach was employed. During cardiac cyst exposure, hypotension developed, necessitating cardiopulmonary bypass (CPB) (without arrest). Complete excision was achieved without myocardial loss or left ventricular communication. Hepatic cysts were removed 1 month later. Albendazole was continued for 3 months postoperatively with weekly liver function test (LFT) monitoring. Full recovery was observed at 6 months, and a 24-month surveillance plan was established.

Cardiac hydatid cysts are often asymptomatic until rupture. TTE is first-line; CT (or MRI) aids in surgical planning. In multi-organ disease, cardiac resection is prioritized. Intraoperative hypotension may mandate CPB, even without pre-existing instability. Perioperative albendazole reduces recurrence.

Synchronous cardiac and hepatic hydatidosis in children requires a multidisciplinary staged approach prioritizing cardiac resection. Complete excision without myocardial loss, CPB if hemodynamic compromise occurs during exposure, and perioperative albendazole (15 mg/kg/day with LFT monitoring) are safe and effective, ensuring full recovery and preventing recurrence.