Left Ventricular Echinococcus Cyst in a 9-Year-Old Girl

Background: Echinococcus granulosus is a parasitic worm which is found in the intestine of the carnivore host. Infection of humans occurs via fecal-oral transmission of worm eggs and can cause cystic echinococcosis (CE). CE is characterized by cysts mainly in the liver and lungs, but cysts can also occur in other organs. Cardiac manifestations are rare and patients with myocardial CE cysts can be asymptomatic or present with dysrhythmia or impaired ventricular function. Diagnosis via echocardiography is the gold-standard which is complemented by serology and cardiac MRI or CT. Rupture of myocardial cysts can lead to dissemination of CE and can cause anaphylactic shock. Therapy often includes neo-adjunctive anthelmintic treatment and surgical removal.

Methods: Case report.

Results: This 9-year-old girl (born in Bulgaria, body weight 36 kg, length 140 cm) with hepatic CE underwent abdominal CT which revealed an accidental finding of a fluid-filled mass in the left ventricle (LV). Upon initial presentation at our institution, the patient had no cardiac symptoms. Echocardiography showed a giant CE cyst of spherical shape with an inner diameter of 35 mm, located in the posterior wall of the LV. Cardiac CT and MRI confirmed the diagnosis and showed close proximity of the CE cyst to the left coronary artery. Cardiac and valvular function were normal. Treatment had already been started with albendazole 400 mg/d per os and was continued. The surgical procedure included (i) median sternotomy and cardiopulmonary bypass, (ii) puncture of the cyst to prevent rupture, (iii) incision and repeated lavage with 20% sodium chloride solution and (iv) closure of the cyst. The residual cyst cavity had an intact wall. Surgery and postoperative care were without complications and the patient was discharged 10 days later continuing albendazole treatment. Follow-ups including echocardiography and MRI up to 4 months after surgery were unremarkable.

Conclusion: Cardiac echinococcosis in children is rare and can occur without specific symptoms. If possible, surgical removal of cardiac cysts is recommended. Preoperative thorough diagnostics and interdisciplinary planning of anthelminthic treatment and surgical procedures are important. This includes spillage prophylaxis and partial cystectomy techniques which are essential for the prevention of recurrency and dissemination of CE. Close follow-up for up to 10 years is recommended to detect recurrences early.

Publication History

Article published online:
13 February 2024