Huge interventricular septal hydatid: A rare fatal case.

A 55-year-old female patient presented with exertional dyspnea for 6 months. She had no history of exposure to pet animals. Her physical examination and cardiac examination were normal. Routine laboratory investigations revealed hemoglobin 14 g/dL, total leucocyte count of 10,200/mm3, and platelet count of 2, 10,000/mm3. Liver function tests were normal. A chest X-ray revealed an enlarged cardiac shadow with a thin rim of calcification inside the cardiac silhouette [Figure 1a–d]. Echocardiography revealed a large heterogeneous cystic mass with multiple daughter cysts occupying the interventricular septum [Figure 1b]. Cardiac magnetic resonance imaging (MRI) corroborated the echocardiographic findings [Figure 1c and d]. An echinococcus IgM antibody tested positive. The patient was diagnosed with cardiac hydatid disease with no evidence of disease elsewhere. She developed anaphylactic shock and passed away before further therapy could be planned.

Figure 1

(a) Chest X-ray with thin rim of calcification delineating hydatid cyst (b) echocardiographic image of huge cyst with multiple daughter cysts invading the whole of septum (c and d) magnetic resonance imaging images corroborating the same

The most common sites of hydatid cysts are the liver, lungs, muscles, bones, kidneys, spleen, and the brain.[1] Cardiac hydatids are rare occurring only in 0.5%–2% of all cases.[2] They involve the left ventricle in 60% cases followed by the right ventricle, pericardium, pulmonary artery, and left atrial appendage.[23] Involvement of interventricular septum occurs in 4% of all cardiac cases.[3] Cardiac hydatids are usually asymptomatic with symptoms in only 10% cases.[4] Discharge of cyst content or cyst rupture can lead to anaphylactic shock. Echocardiography, computed tomography, and MRI may clinch the diagnosis. A positive ELISA to echinococcal antigen confirms the diagnosis. We have described one of the rarest presentations of echinococcal disease through this report and its catastrophic outcome.

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