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      A huge cardiac hydatid cyst: An unusual cause of chest pain revealing multivisceral hydatidosis in a young woman

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          Abstract

          Hydatid disease remains endemic in some parts of the world. Cardiac hydatidosis with multivisceral involvement is uncommon but potentially fatal. We report the case of a 36-year-old Tunisian woman admitted with chest pain and T-wave inversion in the inferior leads on her electrocardiogram. Transthoracic echocardiography revealed a large hydatid cyst in the epicardium throughout the left ventricle. Thoraco-abdominal computerized tomography (CT) scan showed several hydatid cysts in the left lung, the liver, and in both breasts.

          After one week of albendazole treatment, surgical excision of the cardiac cyst on cardiopulmonary bypass was carried out as well as excision of the pulmonary and breast cysts. The postoperative course was uneventful and albendazole treatment was continued for six months. Though hydatid cardiac involvement is very rare, it should be considered in the differential diagnosis of atypical chest pain in young patients, especially those living in regions where hydatid disease is endemic.

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          Uncommon locations of hydatid cysts.

          Hydatid disease is endemic in many parts of the world. It may develop in almost any part of the body. The location is mostly hepatic (75%) and pulmonary (15%), and only 10% occur in the rest of the body. In this article, the various imaging findings of hydatid cysts in unusual localizations are reviewed, based on our experience. Findings in brain, cavernous sinus, submandibular gland, thyroid gland, heart, pleura, chest wall, retrocrural tissue, kidney, spleen, pancreas, peritoneal cavity and inguinal canal, breast, bone and soft tissue are discussed.
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            Surgical treatment of cardiac hydatid disease in 13 patients.

            Cardiac hydatidosis is an uncommon but potentially fatal disease. It remains endemic in developed and developing countries. Its clinical presentation ranges from an absence of symptoms to congestive heart failure or other life-threatening sequelae. Herein, we report our clinical experience with the disease. From 1991 through 2009, 7 male and 6 female patients (mean age, 36 +/- 18.3 yr; age range, 10-68 yr) underwent surgical treatment at our hospital for cardiac hydatid disease. Cardiac hydatidosis was established as a component of multiorgan echinococcosis in 8 patients, and it was diagnosed upon echocardiographic examination in the other 5 during investigation of their nonspecific symptoms. Hydatid cysts were found in the left ventricle (in 5 patients); the right ventricle (in 3); the interventricular septum (in 2); and the interatrial septum, right atrium, and left atrium (in 1 each). All 13 patients underwent sternotomy and surgery under cardiopulmonary bypass. No intraoperative rupture or operative death occurred. The only sequela was complete atrioventricular block that necessitated pacemaker implantation in a patient whose hydatid cyst had involved the basal interventricular septum. All patients underwent subsequent treatment with albendazole (400 mg/d). One patient experienced a recurrence 1 year postoperatively. We discuss our surgical approaches, the outcomes in our patients, and diagnostic and therapeutic recommendations.
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              The imaging appearances of hydatid disease at some unusual sites.

              On reviewing our cases of hydatid disease seen over a period of 20 years (1978-1998), we encountered a number of unusual radiological appearances and sites, which are demonstrated in this pictorial review. We briefly discuss the pathology of hydatid disease and its complications.
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                Author and article information

                Contributors
                Journal
                J Saudi Heart Assoc
                J Saudi Heart Assoc
                Journal of the Saudi Heart Association
                Elsevier
                1016-7315
                2212-5043
                01 May 2015
                October 2015
                01 May 2015
                : 27
                : 4
                : 286-291
                Affiliations
                [a ]Department of Cardiology, Hedi Chaker Hospital, Sfax, Tunisia
                [b ]Department of Thoracic and Cardiovascular Surgery, Habib Bourguiba Hospital, Sfax, Tunisia
                [c ]Faculty of Medicine, Sfax, Tunisia
                Author notes
                [* ]Corresponding author at: Department of Cardiology, Hedi Chaker Hospital, Sfax, Tunisia. Selma_charfeddine@ 123456yahoo.fr
                Article
                S1016-7315(15)00034-2
                10.1016/j.jsha.2015.04.003
                4614895
                26557748
                39398408-09ed-4c8d-a618-f491bd5c7786
                © 2015 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 24 November 2014
                : 23 March 2015
                : 23 April 2015
                Categories
                Case Report

                hydatid disease,cardiac hydatid cyst,chest pain
                hydatid disease, cardiac hydatid cyst, chest pain

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