Abstract
Hydatid cysts located in the interatrial septum are especially rare but when they occur, they might cause intracavity rupture. We report on a patient with acute pulmonary embolism caused by an isolated, ruptured hydatid cyst on the right side of the interatrial septum. A 16-year-old-boy with an uneventful history was hospitalized for exercise-induced dyspnea and blood expectorations. Multiple and bilateral opacities were visualized on standard chest x-ray. Signs of right-sided hypertrophy were seen on ECG. Imaging findings led to the diagnosis of pulmonary embolism complicating cardiac hydatid cysts. An operation was performed through median sternotomy to remove the cardiac cyst. The pleural cavity was entered through the fifth intercostal space to withdraw lung hydatid cysts. Operative recovery was uneventful and the patient resumed his normal activities 19 months later. Prompt diagnosis and an appropriate surgical treatment prevented a potentially fatal outcome.
Highlights
Cardiac hydatidosis, a potentially lethal condition, is uncommon (0.5-2% of cases) compared with the high incidence of hepatic and pulmonary involvement accounting for more than 60% and 25% of cases respectively.The right ventricle localization is exceptional and may be revealed by cyst rupture
Hydatid pulmonary embolism generally occurs after an intracardiac rupture of the right ventricle hydatid cyst
We report our clinical and surgical therapeutic approach in a case of a patient who has developed acute hydatic pulmonary embolism due to the rupture of a right atrial hydatic cyst
Summary
A potentially lethal condition, is uncommon (0.5-2% of cases) compared with the high incidence of hepatic and pulmonary involvement accounting for more than 60% and 25% of cases respectively. The right ventricle localization is exceptional and may be revealed by cyst rupture. Hydatid pulmonary embolism generally occurs after an intracardiac rupture of the right ventricle hydatid cyst. We report our clinical and surgical therapeutic approach in a case of a patient who has developed acute hydatic pulmonary embolism due to the rupture of a right atrial hydatic cyst. Angioscan of the chest showed distended distal branches of the right and left pulmonary artery due to partial occlusion by cystic lesions and multiple segmental defects with multiple pulmonary hydatid localizations (figure 2 and 3). A two-dimensional echocardiography in the apical four chamber view showed a large cystic mass measuring 19 x 22 mm, with a large implantation basis adhesive to the right side of the inter atrial septum with an extension to the right ventricle (figure 4). The pulmonary artery trunk, left and right branches were mildly distended without any proximal cysts. There has been, until recently, no evidence of thoracic hydatidosis recurrence and no signs of chronic pulmonary hypertension
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