2. Case presentation
A 48-year-old female from Tibet, China was admitted to our hospital
presented with a 4-month history of
intermittent pain of chest and back. Each time the pain attacked would
last about 1 hour and usually twice a day, it often followed with mild
fever and headache. For personal history, the patient raised sheep and
cattle for a living. With the exception of a slightly slow heart rate of
47 bpm, her vital signs revealed normal. Cardiac murmur was not found
within each cardiac cycle, the electrocardiogram also revealed no
significant abnormity. For routine laboratory tests, all results
remained in the normal limits, except an elevated percentage of
eosinophils.
Among further cardiac examination, the main anomaly found by
transthoracic echocardiography (TTE) was a slightly weak-echo mass
located at the myocardium of the right ventricular apex (Figure 1,panel A ). Besides the mass, TTE also revealed a patent foramen
ovale, mild tricuspid regurgitationand a small pericardial effusion.
Computed tomography angiography (CTA) of the chest was performed, which
revealed a soft tissue nodule without enhancement within the IVS near
the right ventricular apex, the boundaries between the mass and
surrounding myocardium were indistinct (Figure 1, panel B ). To
clarify the diagnosis, enhanced MRI of the heart was carried out and
revealed a cystic, heterogeneous-intensity IVS mass (3.0cm× 2.8cm) which
was isointensity in T1-weighted images, slight hyperintensity in
T2-weighted images, and no significant enhancement in contrast-enhanced
images (Figure 1, panel C ). Imaging characteristics of CTA and
MRI suggested parasitic infection, thus, further antibody assay of
parasite was performed with a positive result of Echinococcus
granulosus antibody.
After detailed communication, the patient consented to surgical
treatment and signed the operation agreement. The patient underwent
routine median sternotomy, while cardiopulmonary bypass was established
between the superior vena cava, the inferior vena cava and the aorta.
After puncturing and drawing the cyst content, 3% hypertonic saline was
injected into the cyst, and then, the excision of the cyst was done. The
3% hypertonic saline was also poured into the pericardial cavity to
prevent local dissemination. Postoperative
histopathological examination
confirmed the diagnosis of cardiac HC (Figure 1, panel D ). The
patient was discharged from the hospital without complications on the
5th postoperative day and albendazole would be used for at least 6
months to prevent recurrence.