Two-dimensional echocardiographic features of echinococcosis of the heart and great blood vessels. Clinical and surgical implications.

Abstract

Echocardiographic findings in cardiac echinococcosis have been previously described in isolated cases, but no detailed account of the various echocardiographic aspects and their clinical and surgical implications have ever been reported. We present a retrospective analysis of the two-dimensional echocardiograms of 15 patients with hydatid cysts affecting the heart or great blood vessels. Two-dimensional echocardiogram features were compared with the main clinical syndromes. Surgical confirmation of the echocardiogram findings was available in 12 patients. The cyst sizes ranged from 0.5 to 12 cm in diameter. Eleven patients had single cysts, three patients had two cysts, and one patient had multiple cysts. Cysts were located in the intramyocardial region in nine patients, the pericardial in three, and the paracardial in another three. All intramyocardial cysts protruded into the adjacent cardiac chamber, but in only two patients was there significant tricuspid valvular dysfunction. Pericardial and mediastinal cysts showed compression of cardiac chambers or great blood vessels, and two cysts had ruptured into the descendent thoracic aorta or inferior vena cava. In most patients, two-dimensional echocardiographic images of hydatid cysts were those of a cystic mass having well-defined edges and internal trabeculations corresponding to daughter membranes. However, in four patients, two-dimensional echocardiographic images showed a "solid" mass instead of a cystic mass, and in one patient with the multivesicular variety of echinococcosis, the images showed a large mass with poorly defined edges having a honeycombed appearance causing lysis of the anterior arch of the second and third left ribs. The two-dimensional echocardiographic finding showed good correlation with main clinical syndromes, but anaphylactic reactions occurred in every cyst location. In one patient, postoperative two-dimensional echocardiography showed two small intramyocardial cysts that had not been noticed during preoperative two-dimensional echocardiography or during surgical examination. Pathological examination in the four patients with a solid mass showed replacement of the hydatid liquid by necrotic matter containing membrane residues with a foreign-body inflammatory reaction of a granulomatous type. In conclusion, two-dimensional echocardiography is a very useful tool for diagnosis and management of patients with cardiac echinococcosis, but the great diversity of findings regarding number, size, location, and appearance of cysts must be borne in mind to interpret correctly the two-dimensional echocardiograms.