背景:包虫囊肿最常见于肝脏和肺部,很少在心包中发现。诊断和治疗相当具有挑战性,因为这种疾病可以以多种形式出现,这取决于它可能引起的位置和并发症。
方法:一名22岁男子入院前因持续干咳超过1个月来我院就诊。其他症状包括胸痛,疲劳,低烧,和盗汗,在过去的两周里恶化了。体格检查显示呼吸和心功能正常。胸部X线示纵隔增大,左侧胸腔积液。对比增强计算机断层扫描图像显示,在靠近左心房上部的壁囊性肿块病变高达56×50mm。升主动脉和肺动脉,可能位于心包,有10毫米的腔内充盈缺损,发现与包虫囊肿一致,左胸腔积液和周围肺左上叶实变。磁共振成像和经食管超声检查排除了心脏受累。患者接受了受影响肺的细针抽吸和胸腔穿刺术。没有发现恶性肿瘤,同时活检证实存在肺梗死。鉴于影像学检查结果高度怀疑包虫囊肿,我们进行的抗体滴度检测为阴性.患者接受左前外侧开胸手术,心包开放后,在左心房和左肺静脉附近发现了一个直径为5厘米的囊性肿块。用浸渍有高渗溶液(NaCl10%)的纱布分离手术区域后,完全去除囊肿的内容物。肿块导致为棘球囊,其中有多个子囊肿,未穿透/累及(穿孔)心脏壁。
结论:心包包虫病是一种非常罕见的病理,需要高度专业知识的多学科方法。囊肿引起的压迫肿块效应可导致并发症,比如在我们的例子中,肺静脉被压缩了,导致肺梗死.放射学研究和经食管超声检查在诊断中非常重要。在这些情况下,总是建议手术,但是首选的手术方法值得怀疑。在像我们这样的情况下,我们建议开胸前外侧切开术。
BACKGROUND: Hydatid cysts are most frequently located in the liver and lungs and very rarely can be found in the pericardium. Diagnosis and treatment are quite challenging, as the disease can present itself in many forms depending to the location and the complications that it might cause.
METHODS: A 22-year-old man presented to our hospital with ongoing dry cough for more than 1 month prior to admission. Other symptoms included chest pain, fatigue, low grade fever, and night sweats, which have worsened in the past 2 weeks. Physical examination revealed normal respiratory and heart function. Chest X-ray demonstrated mediastinal enlargement and left pleural effusion. Contrast-enhanced computed tomography images showed a walled cystic mass lesion measuring up to 56 × 50 mm in close proximity to the upper left atrium, ascending aorta and pulmonary artery, potentially localized in the pericardium, with a 10 mm endoatrial filling defect, findings were compatible with hydatid cyst, left pleural effusion and peripheral pulmonary upper left lobe consolidation. Cardiac involvement was excluded on magnetic resonance imaging and trans-esophageal ultrasound. The patient underwent fine needle aspiration of the affected lung and thoracocentesis. No malignancy was found, meanwhile the biopsy confirmed the presence of pulmonary infarction. In view of the imaging findings were highly suspicious of a hydatid cyst, we performed a test of antibody titers that was negative. The patient underwent left anterolateral thoracotomy, and after the opening of the pericardium, a cystic mass of 5 cm in diameter was found next to the left atrium and in close proximity with the left pulmonary veins. The content of the cyst was completely removed after the surgical area was isolated with gauze impregnated with hypertonic solution (NaCl 10%). The mass resulted to be an echinococcal cyst with multiple daughter cysts within it that did not penetrate/involve (perforate) the cardiac wall.
CONCLUSIONS: Pericardial echinococcosis is a very rare pathology in which a high expertise multidisciplinary approach is required. The compression mass effect caused by the cyst can lead to complications, such as in our
case where the pulmonary vein was compressed, leading to pulmonary infarction. The value of radiology studies and transoesophageal ultrasound are very important in the diagnosis. Surgery in these cases is always recommended, but preferred surgical approach is questionable. In cases such as ours, we recommend anterolateral thoracotomy.