SESSION TYPE: Critical Care Global Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: The incidence of cardiac involvement among patients with hydatid disease is 0.5-3%, and a pericardial site of implantation is even less common . Severe complications impose a prompt diagnosis and treatment in ED. The management is very critical and time-dependent if the patient develops an anaphylactic shock with cardiopulmonary arrest risk. We present a rare case of multiple pericardial hydatid cysts that resulted in anaphylactic shock.
CASE PRESENTATION: Case history: a 20-years- old man was brought by ambulance to the emergency department (ED) of our hospital, with GCS 6, endotracheal intubation and mechanical ventilation after respiratory arrest in pre-hospital during physical effort (working in a garden). No medical history except some shortness of breath without any specific diagnosis. Physical examination reveals signs of anaphylactic shock (facial edema, edema of the upper lip, bronchial hipersecretion, circulatory collapse) which needed a specific therapy with high-flow oxygen, perfusion with adrenaline, steroids, IV fluids and fresh frozen plasma in emergency room . Based on physical examination the anaphylaxis can be sustained. ECG indicated sinus tachycardia. To identify the etiology of anaphylactic shock, laboratory and imagistic data have been processed. First suspicion came from FAST ultrasonography done by emergency physician which found some liquid formations on the lateral left ventricular wall in the pericardial sac. CBC count showed a leukocytosis, blood acidosis ph =7.28, coagulation disturbance and the chest radiograph showed few encapsulated, homogeneous cystic lesions 25mmx30mm near the left ventricle, confirmed by thoracic and transesophageal echocardiography. Contrast-enhanced CT-scan was performed and revealed a well-defined, thin-walled, multiple liquid formations at the heart apex and near aorta within 10 to 45 mm diameter. With diagnosis of broken intrapericardial hydatid cyst, still intubated with mechanical ventilation and adrenaline on automatic siringe the patient was admitted into intensive care unit, with complete neurology recovery in 12 hours. The pharmacologic therapy with oral albendazol was started and multiple cysts of pericardium were removed during cardiac surgery with complete remission of symptoms. Histopathologic examination of the masses confirmed the diagnosis of hydatid cysts. After discharge, albendazol therapy was followed for one year.
DISCUSSION: Hydatid cyst of pericardium is a rare disease. Transthoracic echocardiography and abdominal echocardiography showed some intrapericardial masses, but the details were not clear due to the poor imaging proprieties. The computed tomography of the chest indicated the diagnosis and the cardiac surgery confirmed the presence of the multiple cystic lesions due to echinococcosis complication. Surgical excision and medical treatment represent the treatment of choice for pericardial hydatid cyst.
CONCLUSIONS: In a patient presenting unconscious status with anaphylactic signs, without anamnesis data, the resuscitation for special circumstances is the key of the emergency management. It’s important to use imagistic methods as well as clinical judgment to identify a rare cause of anaphylactic shock like broken intrapericardial hydatid cyst, a real medical and surgical emergency.
1) European Resuscitation Guidelines for Resuscitation 2010. Resuscitation 81(2010): 1210-1279.
2) Gossios K, Passas G, Kontogiannis D, Kakadellis J, Mediastinal and Pericardial Hydatid Cysts: An Unusual Cause of Circulatory Collapse. AMJ Am J Roentgenol. 2003;181(1):285-6
3) Hafize Yaliniz, Acar Tokcan, Orhan K. Salih, Tumer Ulus. Surgical Treatment of Cardiac Hydatid Disease.A Report of 7 Cases. Tex Heart Inst J. 2006; 33(3): 333-339.
DISCLOSURE: The following authors have nothing to disclose: Diana Cimpoesu, Lucian Stoica, Anda Paulet, Antoniu Petris
No Product/Research Disclosure InformationUniversity of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania