ISSN: 1899-0967
Polish Journal of Radiology
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2018
vol. 83
 
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Letter to the Editor

Imaging spectrum of hydatid disease: usual and unusual locations

Yashant Aswani, Priya Hira

© Pol J Radiol 2018; 83: e160
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- Imaging spectrum.pdf  [0.05 MB]
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Dear Editor,

The article by Srinivas MR et al. [1] provided excellent information on the “Imaging spectrum of Hydatid Disease”. We, however, would like to make the following contributions.
Cardiac infestation by tapeworm accounts for approximately 2% of all cases of hydatidosis in humans [2-4]. Upon ingestion of ova shed in faeces of carnivores (dogs), the asexual phase of life cycle of the cestode continues in sheep. Man, however, happens to be an accidental host [2-4].
The embryo of the worm enters the circulation via the gastrointestinal tract and reaches the myocardium via the coronary arteries [2, 4]. The dominance of left coronary artery and the greater bulk of the left ventricle makes this chamber the most frequently affected site. Inhabitation of right ventricle, pericardium, pulmonary artery, left atrial appendage, and interventricular septum is seen in descending order of frequency [2]. The myocardium may also be involved secondarily by direct contact with cysts in liver [2], lung [2], and mediastinum [4] or by rupture of a lung hydatid into the pulmonary vein [2].
Once inside the myocardium, the embryo transforms into larval stage (hydatid cyst). A differential pattern of growth is seen in different chambers of the heart, with subendocardial and intracavitary growth in the right ventricle and a subepicardial location in the left ventricle [2]. Since the parasite is slow to grow, most often it does not produce any symptoms [2, 3]. The most common presentation is of vague precordial pain [2]. Rupture of the hydatid can lead to catastrophic events including pulmonary embolism, cardiac tamponade, anaphylaxis, and sudden death [2, 3].
Cardiac hydatid can be imaged with echocardiography, computed tomography (CT), or magnetic resonance imaging (MRI) [2]. CT depicts calcification of the cyst wall to an advantage, but the precise anatomic localisation and post-treatment follow-up is best performed with an MRI [2].The cyst is hypointense on T1 and hyperintense with a hypo­intense rim on T2. Morphologically, the hydatid may be unilocular or multinodular, thin or thick walled, and single or multiple in number. A detached inner layer or multiple daughter cysts within are patho­gnomonic appearances [2].
Surgery under cardiopulmonary bypass with pre- and post-interventional benzimidazole therapy is the treatment of choice [2, 4].

References

1. Srinivas MR, Deepashri B, Lakshmeesha MT. Imaging Spectrum of Hydatid Disease: Usual and Unusual Locations. Pol J Radiol 2016; 81: 190-205.
2. Dursun M, Terzibasioglu E, Yilmaz R, et al. Cardiac hydatid disease: CT and MRI findings. AJR Am J Roentgenol 2008; 190: 226-232.
3. Kosecik M, Karaoglanoglu M, Yamak B. Pericardial hydatid cyst presenting with cardiac tamponade. Can J Cardiol 2006; 22: 145-147.
4. Sinner WN. CT and MRI findings of cardiac echinococcosis. Eur Radiol 1995; 5: 66-73.
Copyright: © Polish Medical Society of Radiology This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0). License allowing third parties to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
 
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