Cardiac hydatid cyst in a patient with triple vessel disease
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Hydatid cyst is an infection caused by the larval form of Echinococcus tapeworm. A cardiac presentation of the cyst is a rare scenario.

This patient had a large cardiac hydatid cyst and triple vessel coronary artery disease, thereby posing a double trouble scenario, which was managed successfully by combined medical and surgical approach. An early diagnosis with the help of imaging modalities and serology along with medico-surgical treatment forms the cornerstone of management in these cases.

This is a case of an elderly female who presented with dyspnoea, angina and heaviness of chest, and was found to have ischemic heart disease on electrocardiography. Her echocardiography showed global left ventricular hypokinesia and a pericardial cystic lesion. Cardiac magnetic resonance imaging revealed a loculated mass lesion along the free wall of the left ventricle and triple vessel disease was seen on coronary angiogram. Serum IgG antibodies against Echinococcus were positive. Anaphylaxis and cardiac tamponade due to cyst rupture were the main concerns. Since our patient had two life threatening conditions, a combined surgical and medical approach was opted. She underwent coronary artery bypass grafting along with cyst excision and albendazole therapy; and recovered uneventfully.

The cystic lesion was confirmed on cardiac magnetic resonance imaging (MRI) as a lobulated, heterogeneous mass (measuring 110 × 80 × 60 mm) with multiple daughter cysts infiltrating the free wall of the left ventricle in the mid cavity. The cyst was removed piece-meal and the cyst cavity was given a hypertonic saline wash followed by marsupialization of the cyst wall.

Dr. V●●●●●●j D●●●i
Dr. V●●●●●●j D●●●i Legal Medicine
A legal tip : Rarer the disease/condition, more meticulous should be the notes & records of the case and more should be the involvement/opinion of as many specialists as possible.
Mar 4, 2020Like