Primary echinococcus infection of the heart: a rare type of cystic echinococcosis

T.N.C. Padmanabhan, K.V.K. Kumar, Mohammed Sadiq Azam*, and Anil Kumar Bilolikar

Krishna Institute of Medical Sciences, 1-8-31/1, Minister Road, Secunderabad 500003, Telangana, India

* Corresponding author. Tel: +91 9177618108, Email: drmdsadiq@gmail.com

A 45-year-old Indian soldier, recently diagnosed hypertensive, underwent 2D transthoracic echocardiography as part of his evaluation, which revealed a large cystic mass in the right ventricle (RV) attached to the interventricular septum (IVS) (Panel A). The cystic appearance with multiple septations giving it a cartwheel like appearance due to the presence of daughter cysts within was suggestive of a diagnosis of cystic echinococcosis (CE) of the heart. Serology was positive for Echinococcus granulosus antibody. A magnetic resonance imaging (MRI) scan was done which showed a round, sharply demarcated encapsulated cystic mass with multiple internal septations, attached to the IVS on the RV side and tethered to the septal leaflet of the tricuspid valve measuring 4.1 × 3.3 cm in size. The appearance was consistent with a diagnosis of CE WHO stage CE2 (Panel B). MRI did not detect any other cystic lesions elsewhere in the body. The patient was initiated on Albendazole therapy in view of positive serology test, followed by cyst excision via a right atrial approach (black arrow, Panel C). The excised cyst had 13 daughter cysts within (Panel D) and microscopic examination of an unstained wet mount of the excised cystic fluid demonstrated protoscolices of E. granulosus (Panel E) leading to a definitive diagnosis of CE. He is doing well at 3 months follow-up. Cardiac echinococcosis is a rare manifestation of CE with a reported prevalence of 0.5–2%. Treatment depends on WHO stage which in this case warranted complete surgical removal with adjunctive medical therapy.