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Atypical thoracic pain as form of presentation of a pericardial hydatid cyst

Urbano Gálvez J.M

Infanta Cristina Universitary Hospital
Badajoz, Spain.

Abstract
Introduction
Case
Discussion
Conclusions

Abstract
Introduction: Cardiac hydatic cysts are rare and represent 0.5 to 2% of all hydatic cyst in humans. They are usually found in the left or right ventricle, and exceptionally in the interventricular septum. An exclusively pericardia hydatic cyst is excessively rare.
Case: We present the case of a 44 year-old male with history of several years of evolution of atypical thoracic pain that consults for this reason. In thorax Rx a rounded image of density calcium is observed that for ecografia and thorax CT is proven that it is a hydatic cyst calcified in pericardium. The patient had several dogs and as much in her wife as in two of her children, years before they had been diagnosed of hepatic hydatidosis. In our patient can not objective affectation at any other level. The patient only received symptomatic treatment not specifying surgical treatment.
Conclusions:
1. - The hydatidosis with exclusively pericardial affectation is exceptional.
2. - It is generally diagnosed when the cyst has given complications like break of the cyst.
3. - The diagnoses it is based on technical non aggressives like the echocardiogram and the CT or the MRI for an diagnose precise of face to surgery.
4. - The differential diagnoses of the alive cysts it should be carried out mainly with heart tumors in endemic zones.
5. - The treatment of the dead cysts should be conservative while that of the alive cysts should be aggressive by means of surgery, Mebendazole and later revisions during years.

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Introduction:

Echinococcal infestation of the heart is rare and accounts for approximately 1% of all cases. Sporadic case reports or clinical experience have been reported mostly from areas outside Europe and North America. They are usually found in the left or right ventricle, and exceptionally in the interventricular septum. An exclusively pericardia hydatic cyst is excessively rare. Symptoms of atypical chest pain, dyspnea, and palpitations are common. Drastic complications, including rupture, heart failure, acute ischemic syndromes, and embolization, have been frequently reported.

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Case:

We present the case of a 44 year-old male with history of several years of evolution of atypical thoracic pain that consults for this reason. In thorax Rx a rounded image of density calcium is observed (fig. 1) that for ecografia (fig. 2) and thorax CT (fig. 3) is proven that it is a hydatic cyst calcified in pericardium. The patient had several dogs and as much in her wife as in two of her children, years before they had been diagnosed of hepatic hydatidosis. In our patient can not objective affectation at any other level. The patient only received symptomatic treatment not specifying surgical treatment.

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Fig. 1

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Fig. 2

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Fig. 3

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Discussion:

Cardiac involvement in this disease is uncommon (about l%) is comparison with 1iver or lung (20%) involvement. Hydatid cysts of the heart can result in serious consequences, such as rupture into the circulation with drastic anaphylactic reaction, ischemic syndromes from compression of coronary arteries, or systemic or pulmonary embolization. Other symptoms like conduction abnormalities, most commonly bundle branch blocks, are frequent. Echocardiography remains the most reliable test in the diagnosis of cardiac involvement and localization of cysts within the cardiovascular system.

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Conclusions:

1. - The hydatidosis with exclusively pericardial affectation is exceptional.
2. - It is generally diagnosed when the cyst has given complications like break of the cyst.
3. - The diagnoses it is based on technical non aggressives like the echocardiogram and the CT or the MRI for an diagnose precise of face to surgery.
4. - The differential diagnoses of the alive cysts it should be carried out mainly with heart tumors in endemic zones.
5. - The treatment of the dead cysts should be conservative while that of the alive cysts should be aggressive by means of surgery, Mebendazole and later revisions during years.

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Questions, contributions and commentaries to the Authors: send an e-mail message (up to 15 lines, without attachments) to epi-pcvc@pcvc.sminter.com.ar , written either in English, Spanish, or Portuguese.


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Bioengineering
UNER
Update
Dic/02/1999