Acute cardiac tamponade due to echinococcal cyst of the heart

An echinococcal cyst of the heart is a rare cause of acute cardiac tamponad e. We report on a 24 year old male from the Kosovo who was brought in an em ergency state from a provincial hospital complaining of severe dyspnea, tho racic pain, dizziness, and a short period of unconsciousness. Surgical deco mpression had to be performed urgently, because the pericardium could not b e punctuated due to the position of the hydatid cyst. The differential diagnosis was cardiac tumor or echinococcal cyst. Because of a negative result of a test for anti-echinococcal antibodies (indirect h aemagglutination) and no eosinophilia (5 %), the diagnosis of hydatid cyst was at first discarded. Later on, the test for anti-echinococcal antibodies became positive and a marked eosinophilia (59 %) was manifest. In combinat ion with a typical appearence in the echocardiograph and NMR, the diagnosis of a cardiac hydatid cyst was made. After preoperative treatment with albe ndazole, the cyst was sterilized with a 20 % NaCl solution and the contents evacuated. The therapy with albendazole was continued. When last seen eigh t months after the first incidence, the patient was well except some degree of dyspnea on exertion. As a differential diagnosis of a cardiac tumor, a hydatid cyst should be ta ken into account in patients from an area where Echinococcus granulosus is endemic. A negative test on anti-echinococcal antibodies and the absence of eosinophilia do not rule out echinococcosis.