A rare combination of hepatic and pericardial hydatid cyst and review of literature

Hydatid disease in human beings, as in all intermediate hosts, manifest as hydatid cyst (HC). It is an important cyclozoonotic disease, endemic in various sheep and cattle raising areas of the world, including India. The tapeworm commonly involved is Echinococcus granulosus. HC can occur almost anywhere in the body, most common organs being liver and lungs, and are usually solitary. In 25% of cases combination of liver HC with HC in other extra pulmonary locations are found. Cardiac HCs comprise of 0.5-2% of all HC cases. Within the heart, HCs are usually situated in the left or right ventricle and rarely found in the peri-cardium. Pericardial HC does not produce symptoms and is often painless and silent, until the cysts grow to a large size over the years, when the usual complications develop, such as cyst rupture, cardiac compression, atrial fibrillation, and even sudden death. We describe the case of a 39 year old house wife, of rural origin, with proximity to livestock, who had an asymptomatic pericardial HC along with a symptomatic hepatic HC. She clinically presented with an abdominal lump for one year with recent onset of abdominal pain for 1 month, when radiological imaging confirmed the diagnosis of an unruptured hepatic HC and a pericardial HC. The patient recovered after pericardiectomy along with excision of the HC over the left ventricle and enucleation of hepatic HC, by thoracoabdominal approach. She is doing well after 5 years of followup without recurrence.