Incidental finding of cardiac hydatid cysts, report of two cases

The first patient was a 20-year-old man keeping cows and sheep in house, living in a rural area of southern part of Afghanistan. The patient was complaining from shortness of breath and cough for last one and half year and was referred to undergo chest CT examination. A Contrast enhanced chest CT (with intravenous administration of 80 ml of non-ionic water soluble contrast material mnipaque-350-) revealed a well-defined, thin walled, low attenuating, cystic lesion with lobulated outlines in the anterior segment of the left lung upper lobe, measuring approximately 4.2 × 5.5 × 4.5 cm in size (Fig. 1a, arrow). Another small (1.5 × 1.5 cm) cystic lesion with same characteristics was seen in the anterior segment of right lung upper lobe (Fig. 2- arrow). A lesion of same characteristics was seen in the lateral wall of left ventricle which measured 3.6 × 3.9 × 3.5 cm (Fig. 2- curved arrow and Fig. 3).

Imaged sections through the abdominal cavity revealed at least seven cystic lesions in the liver. The largest lesion in segment seven of liver measured 7 × 8 cm. Some of the lesions demonstrated internal detached membrane, the so called water lily sign (Fig. 1a and b, curved arrows). No solid enhancing components, wall calcification or adjacent infiltrative/inflammatory changes were noted with these lesions.

A 28-year-old shepherd man living in rural area of northern part of Afghanistan with chief complaint of cough and shortness of breath for last four years was referred for a chest CT examination. CT images revealed a large, well defined, fluid attenuating, non-enhancing cystic mass lesion in the left lung mostly occupying the left upper lobe measuring approximately 17 × 11 × 15 cm (Fig. 4a,b). Some internal septations were seen in the superior aspect of this cystic lesion (Fig. 4a- arrow). A multiseptated, fluid attenuating cystic lesion was seen in the cardiac apex measuring approximately 6.5 × 5.7 × 5 (Fig. 5). The lesion demonstrated some peripheral wall calcification in pre- contrast images (Fig. 4-curved arrows).

Keeping in mind multiplicity of the lesions, typical CT features, contact with animals and geographic location of the patients, the diagnosis of hydatid cysts was made for both of the patients.

Unfortunately, as the patients were sent to the authors department only for CT examinations, therefore further clinical and laboratory information (including blood tests and ECG findings) as well as follow up of treatment is unavailable.