Discussion
Due to well-developed transportation, echinococcosis, as a zoonotic
disease, has become a serious global health problem, affecting more than
one million people by hydatid disease worldwide [4]. Compared with
visceral hydatidosis commonly occurring in the liver, cardiac HC is
presented by wide clinical manifestations, leading to an early diagnosis
challenge [13]. According to the WHO-Informal Working Group on
Echinococcosis (WHO-IWGE) ultrasound classification, hydatid cyst
consists of three stages, including active (CE1, CE2, with a high risk
of rupture), transitional (CE3), and inactive or calcified cysts (CE4,
CE5, with a low risk of rupture) [1]. Although most cardiac hydatic
cysts in the literature are reported in young patients, here, we
reported an old lady (68 y/o) with a recurrent hepatic hydatidosis
accompanied by a huge homogenous cystic mass in the cervical and
intracardiac regions. In our case, the cystic lesions in the vicinity of
portal venous confluence and the left portal vein may be considered the
leading cause of extra-hepatic hydatidosis. It is worth noting that the
multiplicity and dispersion of the lesions, typical imaging findings, a
history of husbandry procedures, a history of hepatic cysts, geographic
location, and positive result of serologic test strongly established the
hydatid cyst diagnosis. A previous study represented a 70 y/o female
with no history of being in a sheep-rising area with signs in favor of
right heart failure and cardiac hydatidosis complicated hydatid cyst and
pre-tamponade [14]. Shojaei et al, in Iran, also indicated a cardiac
HC in a 70-year-old farmer with dyspnea. The isolated lesion was
diagnosed by echocardiography and further confirmed with cardiac MRI.
Despite successful surgical excision, he died due to a progressive
arrhythmia [15]. Another report in Iran has also documented an
echinococcal infection involving an intramyocardial multicystic lump in
the posterolateral and basal inferoseptal segments of LV in a
57-year-old farmer man referred with chest pain, and diagnosed by
echocardiography, CMR, and positive ELISA-based serologic test. In
contrast to our finding, EKG examination showed pathological Q and
negative T waves. Similarly, surgery was the treatment of choice,
followed by albendazole as a complementary therapy [3].
In conclusion, a good understanding of the atypical manifestations,
potential associated risk factors, and epidemiology lead to the optimal
and timely management of patients with rare echinococcosis to minimize
worse outcomes.