Pulmonary embolism from cardiac hydatids
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Pulmonary embolism from cardiac hydatids Aamir Mohammad 1 & Mallampati Sameer 1 & Leena Robinson Vimala 2 & Birla Roy Gnanamuthu 1 Santhosh Regini Benjamin 1 & Ravi Shankar 1
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Received: 20 August 2020 / Revised: 23 September 2020 / Accepted: 28 September 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Metastatic hydatid disease of the lung may happen when a hydatid cyst (HC) anywhere in the body ruptures into a systemic vein, a right heart chamber or a pulmonary artery (PA), resulting in the embolisation of the cyst’s contents into the lungs. We submit herewith, the images of embolised hydatids within the PA, in a patient who had surgery for HC involving the right ventricular (RV) wall in 2014. Despite adequate surgical and medical management, investigations in 2017 revealed multiple embolised cysts within PA branches. Further continued medical therapy resulted only in partial resolution of the disease, indicating probably the inadequacy of the currently available treatment strategies. Keywords Hydatid cysts . Syncope . Echinococcus granulosus . Benzimidazole . Pulmonary embolism
The lung is the second most commonly affected organ in the zoonosis caused by the cestode echinococcus. In humans, pulmonary hydatids manifest themselves as cysts, when the oncospheres hatching out of ingested eggs in the bowel find their way into the lungs. Rarely, these eggs may be inhaled. The lungs may also get secondarily infested when a cyst in an adjacent organ erodes into it, or when a pulmonary cyst ruptures into a bronchus [1]. Besides these usual ways of lung involvement, metastatic infestation of the lung may also happen when a hydatid cyst (HC) anywhere in the body ruptures into a systemic vein, right heart chambers or a pulmonary artery (PA), embolising the lungs with its contents—the scolices and the daughter cysts [1]. This embolisation may happen spontaneously, or as a complication of trauma or surgery on a hydatid.
* Birla Roy Gnanamuthu [email protected] 1
The Department of Cardiothoracic Surgery, The Christian Medical College, Vellore, Tamil Nadu 632004, India
2
The Department of Radiology, The Christian Medical College, Vellore, Tamil Nadu 632004, India
A 22-year-old man was diagnosed in 2014 to have a right ventricular (RV) wall hydatid and an emptied left upper lobe of lung (LUL) hydatid, when he presented with complaints of chest pain, breathlessness, cough, salty expectorations and syncope (Figs. 1 and 2a). He had a history of sternal compressions initiated on him during an episode of syncope, by a bystander. When the cardiac cyst was excised, some punctate openings in the base of the pericyst were also closed meticulously [2]. The RV lumen was not opened. Perioperatively, he was treated with four interrupted cycles of albendazole and praziquantel over 6 months. His follow-up investigations over the next two years were normal. In 2017, he complained of mild breathlessness, and investigations revealed metastatic hydatids within some segmental PA, and a recurren
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