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      Pediatric cardiac hydatid cysts: a diagnostic odyssey: a rare case report

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          Abstract

          Introduction:

          Hydatidosis, caused by the Echinococcus tapeworm, typically manifests with hepatic and pulmonary symptoms, but cardiac involvement, especially in pediatric cases, poses a rare challenge. This overview emphasizes the diagnostic complexities and potential complications associated with this uncommon parasitic disease.

          Case presentation:

          A 4-year-old child was presented with epigastric pain after an abdominal impact trauma. Clinical examination revealed tachycardia, fever, and pericardial effusion with an intramyocardial cyst. Hydatid serology confirmed the diagnosis, and subsequent imaging ruled out additional localizations. Treatment involved albendazole, pericardial drainage, and cyst removal, resulting in a favorable outcome.

          Discussion

          Cardiac hydatid cysts, comprising only 0.5–-2% of visceral cases, often occur in underdeveloped regions. The authors’ case, affecting the right ventricle in a pediatric patient, contributes to the understanding of varied presentations. Diagnosis relies on echocardiography, computed tomography scans, and MRI, with surgery being the mainstay treatment. Symptomatic cases demand prompt intervention due to potential complications.

          Conclusion:

          This case underscores the intricate diagnostic journey and management challenges posed by cardiac hydatid cysts, particularly in pediatric populations. Collaboration between medical disciplines is crucial for timely diagnosis and effective treatment, emphasizing the importance of ongoing research in endemic regions.

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          Most cited references10

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          Giant Cardiac Hydatid Cyst in Children: Case Report and Review of the Literature

          Cardiac echinococcus is a rare affliction of the heart caused by the tapeworm Echinococcus granulosus. Primary echinococcosis of the heart represents 0.5–2% of all hydatid disease cases in endemic regions. It evolves slowly, explaining its rarity in children. We report the case of a 11-year-old child affected by a giant cardiac cyst of the left ventricle (LV). The patient underwent cardiac surgery and medical treatment. A retrospective review of the current literature was realized. We found 18 cases: the mean age was 11-years old. Nine cysts were localized in the LV, four in the interventricular septum, three in the right ventricle, and two in the right atrium. All underwent surgery except six patients. Routine echocardiographic screening may be useful in endemic regions where infestation is common. Cardiac echinococcus should be diagnosed in the early and uncomplicated stages and be removed surgically even in asymptomatic patients.
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            Large cardiac hydatid cyst in the interventricular septum.

            Cystic hydatid disease results from infection with the larval or adult form of the Echinococcus granulosus tapeworm. Cardiac involvement is seen in 0.5% to 2% of patients with hydatid disease, and involvement of the interventricular septum is even rarer. Herein, we report our surgical treatment of a large cardiac hydatid cyst in the interventricular septum. A 39-year-old woman presented with dyspnea. Transthoracic echocardiography revealed a large cyst in the apical part of the interventricular septum. Thoracic computed tomography showed a cystic lesion in that site, and magnetic resonance imaging confirmed the presence of a 50 × 55-mm mass. The patient was placed on cardiopulmonary bypass. Hypertonic saline solution-soaked sponges were distributed within the pericardial cavity to prevent local invasion of the parasite intraoperatively. Through an incision parallel to the left anterior descending coronary artery, and without opening adjacent cardiac chambers, we aspirated the entire contents of the cyst, removed its germinative membrane, and washed the cavity with 20% hypertonic saline solution. The patient recovered uneventfully. She had begun taking albendazole 5 days preoperatively, and this therapy was continued for 12 weeks postoperatively. In cases of an interventricular cardiac hydatid cyst, the combination of surgical resection, washout of the remaining cavity with hypertonic saline solution, and albendazole therapy typically yields excellent results.
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              Primary cardiac hydatid cyst presenting with massive pericardial effusion: a case report

              Background Cardiac hydatidosis is a rare manifestation of Echinococcus infection. It represents 0.5 to 2% of hydatic disease (Mustafa et al., Can J Cardiol 22:2, 2006). The most common localization is the myocardium of the left ventricle but can also touch the right ventricle, atrium, pericardium, interventricular septum, and pulmonary artery. Clinical presentation is varied ranging from clinical latency or minor symptoms to cardiogenic shock and sudden death. The present case describes a primary pericardial hydatid cyst, a very exceptional localization of cardiac hydatidosis, which can lead to a delayed diagnosis or to an erroneous treatment that can expose the life of the patient to complications and death if it is not considered. Diagnosis can be established by cardiac imaging and hydatid serology. Therapy management should combine both surgery and medical treatment by albendazole or mebendazole. Case presentation We report a 70-year-old woman from Sale, who was admitted for dyspnea New York Heart Association (NYHA) class IV evolving in a febrile context with signs of right heart failure related to a rupture of a primary pericardial hydatid cyst with pre-tamponade. The diagnosis was confirmed by echocardiography, computed tomography scan (CT scan), and hydatic serology, and the patient was operated and put on albendazole for 3 months with favorable clinical course. Conclusions The aims of this article are to consider the diagnosis of cardiac hydatid cysts in the presence of pericardial effusion, especially if there is a prior history of hydatid disease, a contact with animals, or when it occurs in an endemic country, and to be able to make a differential diagnosis with cardiac imaging in order to avoid its complications and to guide the management.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                MS9
                Annals of Medicine and Surgery
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2049-0801
                August 2024
                10 June 2024
                : 86
                : 8
                : 4776-4779
                Affiliations
                Departement of Cardiology, University Hospital Ibn Rochd Casablanca, Casablanca, Morocco
                Author notes
                [* ]Corresponding author. Address: 91 Rue ALBANAFSAJ Residence Aline appartement 9 3eme étage BENJDIA 20250. Tel.: +21 261 780 7957. E-mail: Zahrisoukaina@ 123456gmail.com (S. Zahri).
                Article
                AMSU-D-24-00186 00070
                10.1097/MS9.0000000000002093
                11305765
                39118755
                59c9e86a-c912-4b68-970d-8666e0da4c59
                Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                : 23 January 2024
                : 9 April 2024
                Categories
                Case Reports
                Custom metadata
                T
                TRUE

                hydatidosis,pediatric,cardiac involvement,pericardial effusion

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