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Cardiac Echinococcossis

date : 23.10.2014

Radina Antova
Kamelia Genova

Department of Diagnostic and Interventional Radiology, National Heart Hospital, Sofia, 1309


Keywords: echinococcosis, mediastinal cysts, hydatid cyst, cadiac tamponade

Clinical history: We present a 17 years old girl, diagnosed at the age of 13 with mediastinal echinococcosis. The diagnosis was confirmed first echocardiographically and then operatively and serologically. The patient had several hospitalizations for urticaria, pretamponade, and pneumonia. Her latest complaints were: palpitation, chest pain, hypotonia, and syncope.

Imaging findings:

Cardiac CT shows cystic mass (52,9 mm) in the upper middle mediastinum, posterior to the SVC, narrowing its lumen to 50%. The formation compresses the right superior pulmonary vein and narrows its lumen by 90%. Two satellite lesions with similar morphology are found below the right inferior pulmonary vein. Another multicystic lesion with thick wall and multiple calcifications infiltrates the left myocardium free wall, compresses the annulus of the MV and its posterior leaflet, which is blocked and with reduced mobility. Functional study shows low-velocity jet phenomenon proximally to the MV based on slightly reduced ESV and EDV, with a slight decrease in the EF and SV (50%). There is a small foramen ovale with a small degree of shunt. No signs of pulmonary consolidation. No signs of pleural or pericardial.

Final diagnosis: cardiac echinococcosis


Echinococcosis is a zooantroponosis, caused mainly by the tapeworm of E. Multilocunaris, which life cycle involves two hosts, one host-a definitive carnivore host and the other intermediate herbivore host. The intermediate hosts are infected after ingesting viable oncosphere- containing eggs, which then penetrate the intestinal wall and enter the portal circulation. That is the reason why the liver is the most common location (70%). If the oncospheres pass the liver, they reach the lung (15%). Cardiac echinococcosis is 0,5-2% of cases of hydatidosis. Contractions of the heart provide a natural resistance to the presence of viable hydatid cyst. Any part of the heart may be affected. The disease can remain asymptomatic in 90% of cases. The cysts tend to grow and thus compress the neighboring myocardium, coronary arteries, atria; they can cause mechanical interference with the AV valves and rhythm disturbances. The clinical manifestations of cardiac echinococcosis depend on size, number and localization of the cysts. The disease may result in heart failure, cardiac tamponade, PE, arrhythmia, mitral insufficiency, CAD, anaphylaxis and death. The growing of the incorporated in the myocardium cysts causes reduced contractility and thus decreased EF, which is related to heart failure symptoms - fatigue, swelling of the inferior extremities, etc. Cysts located next to AV valves can compromise their function. In our clinical case, the mitral valve is infiltrated by and old, calcified organized cyst, which causes blockade of the posterior leaflet and prolapse of the anterior leaflet. The cyst, which compresses the right pulmonary veins, increases intraluminal pressure in the pulmonary venous system. The clinical features include dyspnea, repeated pulmonary infections, chest pain, and palpitations. Compression of the SVC causes SVC syndrome – swelling of the head, neck, upper extremities, dyspnea, cough, chest pain, headache, dizziness, and syncope. In our case there repeated syncope, persisting dizziness and chest pain. The compression of coronary arteries can mimic ischemic heart disease. In our case there are symptoms resembling ischemic heart disease, without laboratory signs of myocardial necrosis. Infiltrating the myocardium can cause rhythm disturbances – by compressing the conduction systems of the heart or by forming arrhythmogenic zones in the myocardium - symptoms lacking in our clinical case. Diagnosis can be obtained trough the combined assessment of radiological and laboratory data. Echocardiography is a reliable method for visualizing cystic formations in the heart chambers. Pitfalls of the method are the inability for visualization of extra cardiac structures and limited acoustic window. Sometimes it is not possible to distinguish whether the cyst is in the myocarduim or in the pericarduim. CT and MRT are more precise methods as they can determine morphology, anatomic localization, and the limits of these lesions. CT has high spatial resolution and is the most sensitive method for detecting calcifications. CT often accurately defines the relationship of the lesion with the adjacent structures and pulmonary involvement. MRT is important for displaying the structure of these lesions and involvement of neighboring tissues but it is insufficient in displaying calcifications and pulmonary lesions.

Differential diagnosis:

mediastinal cysts: bronchogenic, pleuro-pericardial, thymic, intramural cysts of the esophagus, lymphangioma etc.

Take home messages:

Echinococcosis is е widely distributed in our region chronic parasitoid infection, which is characterized, by forming of parasite mainly in the liver, lungs, spleen, and kidneys. Cardiac and vascular hydatid cysts are very rare. The clinical manifestation of the disease depends on size, localization and presence of complications. Diagnosis can be obtained through the assessment of clinical, radiological, laboratory and historic data. Echocardiography, CT and MRT facilitate diagnosis. CT is an essential method for displaying morphology of the cysts, displaying calcifications and presence of complications.


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