Download Simultaneous heart, lung, and breast hydatid cysts operated

Simultaneous heart, lung, and breast hydatid
cysts operated in a single session
Hèla Ben Jmaà1*, Abir Bouassida1, Abdessalem Hentati1, Faten Triki2, Taieb Cherif1, Salma Charfeddine2,
Sayda Masmoudi1, Abdelhamid Karoui3, Imed Frikha1
ABSTRACT The multivisceral location of the cardiac hydatid cyst is exceptional. A 37-year-old female, who was operated on two years ago for hydatid cysts of the
right lung, was asymptomatic. A CT scan defined cystic masses of the heart, the left lung, and the liver, as well as cysts in the two breasts. Thus, the patient
was given a cardiopulmonary bypass via a sternotomy. The intra-operative examination revealed a cyst of the inferior wall of the left ventricle. All of the
cysts were excised in a single session, and the patient was discharged on the fourth postoperative day without symptoms.
Keywords: echinococcosis, cardiac mass, multivisceral location, surgery.
RÉSUMÉ Chirurgie combinée de kystes hydatiques du cœur, du poumon et des seins
La localisation multiviscérale du kyste hydatique cardiaque est exceptionnelle. Une femme âgée de 37 ans, opérée il y a deux ans pour kyste hydatique
du poumon droit, est asymptomatique. Un contrôle scanographique a révélé une masse kystique du cœur, du poumon gauche, du foie, et des masses
des deux seins. La patiente a alors été opérée sous circulation extracorporelle à travers une sternotomie. L’exploration peropératoire a révélé un kyste
de la paroi inférieure du ventricule gauche. Tous les kystes ont été excisés en un même temps opératoire, et la patiente a été déchargée au quatrième
jour postopératoire.
Mots clés : echinococcosis, masse cardiaque, localisation multiviscérale, chirurgie.
1. INTRODUCTION
Hydatid cysts of the heart are rare and the prevalence of cardiac hydatidosis is less than 2% of all human body infestations
[1, 2]. They can be a serious and a life-threatening problem. Predominantly registered locations include the left ventricle (75%),
followed by the right ventricle (18%) and the interventricular septum (7%) [3]. Likewise, multi-visceral hydatidosis is an exceptional
condition.
We present the case of a 37-year-old woman who had a previous
history of surgery of echinococcosis of the right lung, and who
underwent a successful surgery for multiple hydatidosis of the
left ventricle, the left lung, and the two breasts at the same time.
2. CASE REPORT
We report a case of a 37-year-old woman with a past history of
surgical removal of four hydatid cysts of the right lung. Following
surgery, she received antihelmintic treatment with albendazole
for two years until a Computerized Tomographic (CT) scan of the
thorax and abdomen revealed well-defined cystic lesions in the
left atrium [figure 1], the left lung, the liver, and the two breasts.
Thus, surgery was planned.
Preoperative trans-thoracic echocardiography defined a cystic
mass lesion of 50 x 40 mm originating from the apex of the heart
and protruding into the pericardium. The coronary angiography
was normal. The patient underwent surgery via a sternotomy,
Figure 1. CT scan showing a cystic mass in the left atrium (arrow).
1. Department of cardiovascular and thoracic surgery Habib Bourguiba
Hospital Sfax, Tunisia.
2. Department of cardiology Hedi Chaker Hospital Sfax Tunisia.
3. Department of anesthesiology Habib Bourguiba Hospital Sfax Tunisia.
* Auteur correspondant : [email protected]
Conflit d’intérêt : aucun. / Conflict of interest statement: none declared.
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Chirurgie Thoracique et Cardio-Vasculaire 2015 ; 19(4) : 244-245
Figure 2. Operative view of the left ventricular cyst protruding
into the pericardium (arrow).
cas clinique
Figure 3. Operative view of the cystic cavity (arrow).
Figure 4. Intraoperative view of removal of hydatid cyst from the breast.
and under cardiopulmonary bypass between the ascending aorta
and the two vena cava. The intraoperative examination revealed
that this cyst originated from the inferior wall of the left ventricle
[figure 2].
Hypertonic solution was introduced into the cystic sac. The cystic content was then carefully aspirated, draining the viscous
fluid. Then, a cystectomy was performed and the remaining cyst
contents and germinative membrane was removed. The cystic
cavity was large [figure 3] and was closed using a direct suture.
After decannulation, the cysts of the left lung and the two breasts
were removed [figure 4].
The postoperative period was uneventful, and the patient was
discharged from the hospital on the fourth postoperative day
without any complication. The patient was treated with albendazole to prevent recurrence.
The median sternotomy is suitable for this surgery. This involves
the least amount of postoperative chest pain, and avoids deterioration of the respiratory function. In addition, it also decreases
the length of the hospital stay [7].
3. DISCUSSION
Hydatid disease is a parasitic infestation caused by Echinococcus granulosus, which uses the dog as a definitive host. Humans are the accidental intermediate host in the life cycle of
the parasite and can be affected through handling of infected
dogs or by ingestion of water or food contaminated with parasite eggs [4].
The liver (70%) and lungs (25%) are the most frequently affected
organs. The cardiac location is rare. The most frequently affected sites of the heart are the left (75%) and the right ventricles
(18%), and the interventricular septum, whereas the pericardium,
left and right atria are the least often affected [5]. Most of the
cases have large and often asymptomatic cysts in the heart [4,
6]. The diagnosis of cardiac cyst hydatid may be difficult due to
the nonspecific symptoms and varying clinical presentations. It
can, however, be confirmed using non-invasive investigations,
particularly echocardiography.
The cardiac and lung hydatid cyst one-stage operation has a lot
of advantages. The patient is operated on just once, rather than
undergoing multiple surgeries. As a result, deterioration of the
patient’s general condition during the period between the operations is avoided and the period of rehabilitation, as well as the
treatment costs, is considerably reduced.
REFERENCES
4. CONCLUSION
Multi-organ involvement is common with cardiac echinococcosis, thus the reported prevalence of cardiac hydatidosis would be
higher if cardiac structures were routinely studied in patients with
multiple hydatid cyst disease [8]. Due to the fatal consequences
of the above-mentioned serious complications, surgical excision is the treatment of choice. One stage surgery in patients
who have cardiac and lung hydatid cysts using cardiopulmonary
bypass by median sternotomy is safe and satisfactory.
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