Left ventricular hydatid cyst: an uncommon cause of chest pain in young adults.

Isolated cardiac involvement in hydatid disease is very rare. We report the case of a young adult male who presented to the emergency department with acute onset of chest pain and was surprisingly detected to have a hydatid cyst in the left ventricular myocardium. The transthoracic echocardiography and cardiac magnetic resonance imaging confirmed the diagnosis. Cardiac hydatid disease should be considered in the differential diagnosis of chest pain in young individuals in the absence of conventional risk factors of atherosclerosis.

[Cardiac hydatid cyst about 17 operated cases]. / Les kystes hydatiques cardiaques à propos de 17 cas opérés.

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period. METHODS: Between May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25±13years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest. RESULTS: Our study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n=2). Morbidity was marked by conduction abnormalities (n=2), bleeding and hematoma of the residual cavity that required surgical treatment (n=3). Eleven patients were followed with a mean period of 40.5±19.4 months. At follow-up, neither late deaths nor recurrence have occurred. CONCLUSION: Cardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.

[Unusual location of multiple hydatidosis, pancreatic and pelvic: about a case]. / Hydatidose multiple à localisation inhabituelle, pancréatique et pelvienne : à propos d'un cas.

Hydatid cyst is an infectious disease which is quite frequent in Morocco. Pelvic and pancreatic locations of this parasitic infection are rare, namely exceptional. We report the case of a 66-year old patient who was operated for liver hydatic cyst 6 years before, presenting for chest pain associated with hydatidoptysis. Chest X-ray objectified left hydropneumothorax. Thoraco-abdominopelvic CT showed mediastinal liquid mass as well as multiple hepatic, pancreatic (isthmus), pelvic and left under diaphragmatic cystic lesions. Hydatid serology was positive. Treatment involved thoracotomy associated with medical treatment.

[Pulmonary hydatid cyst: unusual double apical location. About a case]. / Kyste hydatique pulmonaire: double localisation pulmonaire apicale inhabituelle. A propos d'un cas.

Hydatid cyst (KH) is still endemic in several areas of Morocco. Pulmonary involvement is a consequence of liver disease. Hydatid cyst is characterized by diverse anatomical and clinical presentations and by the possibility of multiple locations within the lung parenchyma, predominantly involving pulmonary bases. We report the case of Mr J. M, 54 years old, admitted with suspected pulmonary hydatid cyst based on chest pain lasting for six months and an episode of hydatidoptysis. Chest x-ray objectified a double apical location suggesting different stages of evolution for pulmonary hydatid cyst. The diagnosis was confirmed by thoracic CTscan and hydatid serology. Multiple pulmonary hydatid cyst is not rare in areas in which hydatid disease is highly endemic. Our study reports an unusual double apical location of hydatid cyst at various stages of evolution.

Pseudo-tumor of the lung, a rare clinical presentation of dirofilariasis.

INTRODUCTION: Pulmonary dirofilariasis is an uncommon entity. Known as a zoonotic disease it can affect humans as a secondary host. A pseudo-tumor of the lung called "coin" lesion is usually detected while performing a chest X-ray for another reason. OBSERVATION: We present a case of pulmonary dirofilariasis due to Dirofilaria sp. in a 72 year old immunocompetent patient who underwent surgery for suspicion of a neoplasm. DISCUSSION: Human pulmonary dirofilariasis should be evoked in asymptomatic patient from endemic area of canine dirofilariasis presenting with a pseudo tumor of the lung.

Filarial hydropneumothorax: a strange journey.

Filarial infection can have varied manifestations, but hydropneumothorax at presentation has not yet been reported. A 28-year-old man presented to our hospital with heaviness of the left chest for the past 10 days, which was preceded by a sudden, short stabbing pain in the left chest after straining. Chest X-ray revealed left-sided hydropneumothorax. A peripheral blood picture revealed significant eosinophilia. A pleural fluid report also showed eosinophilia and a few motile microfilaria of Wuchereria bancrofti. Microfilaria was also documented in peripheral blood. There was no evidence of other organ system involvement. The patient was diagnosed with 'Filarial Hydropneumothorax'. After treatment with a temporary chest drain and oral diethylcarbamazine citrate, there was dramatic relief of symptoms and radiological improvement. The patient has been symptom free with no features of recurrence through 8 months of follow-up.

Severe chest pain due to gastric anisakiasis.

We treated two cases of gastric anisakiasis presenting with severe chest pain. In both cases, there was a history of prior ingestion of raw saltwater fish. After endoscopic removal of larvae, the chest pain disappeared and never recurred. Other diseases causing chest pain were ruled out by symptoms, signs, blood tests, electrocardiography, chest radiograph, and ultrasonic examination of the heart and abdomen. Thus the chest pain was considered to be caused by gastric anisakiasis. Gastric anisakiasis should be included in the differential diagnosis of acute chest pain.

Amoebic liver abscess in pregnancy: report of two cases.

Amoebic liver abscess is a rare complication of pregnancy. It however, carries significant morbidity and because the diagnosis is often delayed, physicians in developing countries need to be reminded of its possibility when patients present with right lower chest and abdominal pain. This study presents the clinical reports of two cases in which the diagnosis was delayed and review the literature on amoebic liver abscess in pregnancy.

Trauma exposure and posttraumatic stress disorder in primary care patients: cross-sectional criterion standard study.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is one of the most common but least recognized anxiety disorders in primary care. This study aimed to describe the association of PTSD and trauma exposure with somatic symptoms, psychiatric comorbidity, functional impairment, and the actual treatment of PTSD in primary care. METHOD: This cross-sectional criterion standard study included 965 consecutive primary care patients from 15 civilian primary care clinics in the United States. The Structured Clinical Interview for DSM-IV (SCID) was used to establish diagnosis of PTSD and other anxiety disorders. Somatic symptoms, depression, and anxiety were measured with the Patient Health Questionnaire (PHQ), and functional impairment was measured with the Medical Outcomes Study Short-Form General Health Survey (SF-20). The study was conducted from November 2004 to June 2005. RESULTS: PTSD was diagnosed in 83 patients (8.6%; 95% CI, 7.0%-10.5%), and trauma exposure without fulfilling DSM-IV criteria for PTSD was reported by 169 patients (17.5%; 15.2%-20.0%). With odds ratios ranging between 2.1 (95% CI, 1.2-3.6) for headache and 9.7 (3.8-24.8) for chest pain, PTSD patients had markedly elevated somatic symptom rates compared to the reference group of patients with no PTSD or trauma exposure. PTSD was significantly associated with elevated rates of psychiatric comorbidity, pain, and impaired functioning. Patients reporting trauma but no PTSD had rates of somatic symptoms, psychiatric comorbidity, and functional impairment that were intermediate between PTSD and reference group patients. Adjusting for depression substantially attenuated the association of PTSD and trauma with somatic symptoms, suggesting that depression may be an important mediator of the PTSD-somatic symptoms relationship. CONCLUSIONS: The high frequency of PTSD in primary care and its association with psychiatric comorbidity and functional impairment underscore the need to better detect and treat PTSD in primary care. Recognizing the frequent somatic presentation of PTSD and appreciating the salience of comorbid depression may be especially important in optimizing PTSD care.

Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts.

OBJECTIVE: The purpose of this study was to review 97 patients with giant pulmonary hydatid cysts and assess the clinical features and results of different operative techniques over a 27-year period. MATERIAL AND METHODS: Between January 1981 and December 2007, 590 patients were operated on for pulmonary hydatidosis and 97 (17 %) of these patients had giant pulmonary hydatid cyst. We retrospectively reviewed the medical records of these 97 patients. The diameter of the hydatid cysts were measured using radiological methods and intraoperatively. RESULTS: Seventy-eight patients were male (80 %) and 19 were female (20 %). The median age was 23.4 years (range: 15-63 years). The most common symptoms were chest pain (54 %), cough (43 %) and dyspnea (41 %). Fourteen patients were asymptomatic (14 %). The diameters of the cyst ranged between 10 and 25 cm (mean 13.8 cm). The cysts were located in the right hemithorax in 52 (54 %) patients, in the left hemithorax in 44 (45 %) patients and bilaterally in one patient (1 %). Five patients had more than one cyst. The procedures consisted of cystotomy and capitonnage in 53 patients, enucleation and capitonnage in 27 patients and simple cystotomy or enucleation in 8 patients. Anatomical resection was performed in 9 patients. Prolonged air leakage of more than 7 days occurred in five patients; one patient underwent an operation and a Heimlich valve was placed in two patients. There was no postoperative mortality. Recurrence was not detected at follow-up after 6 months and 27 months. CONCLUSION: The higher lung tissue elasticity and delayed symptoms due to localizations of the cyst are the reasons for the occurrence of giant hydatid cysts in the lung. A parenchyma-saving operation should be performed instead of anatomical resection because of the low complication rates and because most complications can be treated conservatively.

Multiple mediastinal hydatid cysts: a case report.

Hydatid cyst (HC) in mediastinum is very rare. To the best of our knowledge, a case with multiple HCs in mediastinum is not reported already. We herein report a case of multiple HCs of the mediastinum and liver in a - 50 year-old woman presented with chest pain, cough and dyspnea for about two years. She had been treated for tuberculosis for 20 years. Chest CT scan showed multiple cysts in posterior mediastinum and one cyst in left lobe of liver. Via right posterolateral thoracotomy, multiple cysts were excised in mediastinum. And then, hepatic left lobe cyst was removed trans-diaphragmatically. Histopathologic examination confirmed HCs. Despite its rarity, primary HCs should be considered in the differential diagnosis of mediastinal multiple cystic lesions in endemic regions.

Primary hydatid cyst of the posterior mediastinum.

Hydatid cystic disease is still a health problem in Morocco. Mediastinal localization is very rare. We report the case of a 24-year-old man who presented with right chest pain and dyspnea. Chest X-Ray and computed tomography showed a mediastinal mass. The diagnosis was confirmed perioperatively by macroscopic and histologic investigations. Resection of the cyst was performed, and a small part intimately adherent to the inferior vena cava and oesophagus was left in place. There were no complications or recurrence.

Surgical approach of pulmonary hydatidosis in childhood.

To review the results of different surgical treatment in hydatid disease of the lung in paediatric patients. A total of 102 children with pulmonary hydatid cysts were treated at the our clinic in the period from 1990 to 2001. There were 59 boys and 43 girls and their age ranged from 4 to 16 years (mean 10.2). Chest radiography, computed tomography and abdominal ultrasonography were the most commonly used diagnostic techniques. The cysts were located in the right lung in 68 patients (66.6%), in the left lung in 30 patients (29.4%), in both lungs in four patients (3.9%). Concomitant liver cyst hydatid was also detected in 12 patients that were located at right lung, and two patients with bilateral lung involvement. All cases were managed surgically. Of 14 cases with concomitant liver and intrathoracic hydatid cysts, right thoracophrenotomy was performed in 12, median sternotomy in one, and phrenotomy in other. Partial cystectomy and capitonnage were the most commonly used surgical methods. Post-operative complication was seen in 10 (9.8%) patients. Infection at the incision site occurred in four patients and air leakage in three. Complications of capitonnage were seen in three patients. One patient (1%) died at fourth post-operative day due to sepsis. Parenchyma protective operations should be performed especially in children living in endemic areas because of the possibility of recurrence of the disease in the future. Single stage operations in suitable cases decrease the cost of treatment and make surgical therapy suitable in both children and young adults, by reducing the hospital in-patient time and morbidity.

Common presentations of amebic liver abscess.

STUDY OBJECTIVE: The most common extraintestinal manifestation of Entamoeba histolytica, the agent of amebiasis, is a hepatic abscess. This infection is common throughout the world and can be associated with life-threatening consequences. Given the often nonspecific nature of the complaints related to an amebic abscess, a retrospective review of patients with confirmed disease was done to recognize the most common patterns of presentation. METHODS: A retrospective case series was conducted of all patients with confirmed amebic liver abscess over a 5-year period. All available emergency department and inpatient records were reviewed. Age, sex, country of origin, chief complaint (including duration), vital signs, and physical and laboratory findings were recorded. The use of ultrasonography, computed tomography scan, chest radiograph, and serum antibodies was noted, as well as the final ED diagnosis. RESULTS: Seventy-five patients were reviewed; mean patient age was 35.5 years, 80% were male, and Mexico was the country of origin for 64%. The most common complaint was fever (77%), followed by abdominal pain (72%), which was most often located in the right upper quadrant. Cough (16%), chest pain (19%), and chest radiographic abnormalities (57%) were also common. The majority of patients (69%) had symptoms for less than 13 days. The WBC count was the most consistent laboratory abnormality (83%), whereas the liver aminotransferase, alkaline phosphatase, and bilirubin levels were often normal. Most patients received their diagnoses on the basis of ultrasonography (85%), followed by a confirmatory serum antibody titer (88%). The diagnosis of amebic liver abscess was correctly made in the ED in 31.5% of the patients, with the most common misdiagnoses being cholecystitis (16.4%), hepatitis (12.3%), and pneumonia (9.6%). CONCLUSION: Patients with amebic liver abscess do present to EDs in the southwestern United States, especially in areas with a high immigrant population from endemic areas. Patients with complaints of fever and right upper quadrant abdominal pain, especially men of Hispanic origin, warrant a high degree of vigilance. Whereas most laboratory studies are unhelpful, the diagnosis can often be made in the ED by means of a bedside ultrasonographic test. Treatment should be initiated with metronidazole with disposition to an inpatient medical service.