| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
General Hospital of Ioannina Ioannina 45001, Greece
Hydatid disease is a parasitic infection that is endemic in many parts of the world. Hydatid cysts in humans are usually found in the liver and lungs [1]. We present a rare case of mediastinal and pericardial hydatid cysts that resulted in circulatory collapse.
A 61-year-old man was admitted to the emergency department of our hospital with signs of circulatory collapse. The patient's medical history included an accident in which he sustained injuries that had required removal of his spleen and left kidney. In addition, he twice had developed and had undergone surgical removal of a pulmonary hydatid cyst in his right lung. Results of laboratory studies were normal. A chest radiograph showed a well-defined rounded opacity in the right lung that was in continuity with the cardiac shadow. Echocardiographic findings were normal.
Contrast-enhanced CT confirmed the presence of a well-defined, thin-walled, homogeneous cystic mass with internal trabeculae. The mass measured 6 x 7 cm, was located in the right middle lobe, and had a wide attachment to the pericardium but caused no effusion (Fig. 3A). CT also revealed another large cystic mass with indefinite margins located in the posterior and middle mediastinum, compressing the right pulmonary artery (Fig. 3B). We did not perform MR imaging because of the presence of abdominal metallic clips from the previous surgery. The pericardial cyst was surgically removed. The mediastinal cyst was ruptured, drained, and partially removed. Histopathologic examination of the masses confirmed the diagnosis of hydatid cysts.
|
|
The incidence of cardiac involvement among patients with hydatid disease is 0.5–3%, and a pericardial site of implantation is even less common [2]. A mediastinal site for the disease is also rare compared with a pulmonary location [3, 4]. The latency period between infection and presentation of the disease is long, and clinical features depend on the size and location of the cysts and the presence of complications. Presenting symptoms include anaphylactic reactions or even circulatory collapse, as seen in our patient [5].
In this patient, CT was useful for determining the presence of the mediastinal cyst in an area difficult to visualize on chest radiography. The typical CT findings of the pericardial cyst containing daughter cysts, and the patient's medical history, allowed us to presume that both masses were hydatid cysts. On the basis of these findings, we attributed the circulatory collapse to the partial rupture of the mediastinal cyst because of its size, distribution, and margins. For these reasons, complete removal of the mediastinal cyst would have been difficult.
This patient represents an unusual case because the site of the hydatid recurrence was in mediastinum and pericardium. In a patient with a history of hydatid disease, the rupture of a hydatid cyst should be considered a possible diagnosis when circulatory collapse is the initial symptom.
References
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
