oa Robot-assisted Excision Of An Unusual Apical Pericardial Hydatid Cyst

Background: a 30 year old gentleman was referred to our in thoracic surgery clinic with an incidental finding of an abnormal shadow around the apical region of the heart on the chest radiograph. He was asymptomatic and non smoker and he had no chronic medical illness in the past. He had no specific findings on physical examination. Echocardiogram revealed rounded cyst in the pericardium around the hear apex measuring 5.9 by 4.1cm. Chest CT Angiography revealed no evidence of coronary artery disease. Magnetic Resonance Imaging (MRI) showed a well defined round pericardial cyst close to the left ventricular apex but there was no evidence of infiltration the left ventricle or wall abnormal enhancement. Procedure and Findings: He underwent robotic excision of the cardiac apical cyst. An inflamed 5 by 6cm cystic mass was found densely adherent to the apical pericardium. There were no adhesions or pleural effusion and the lungs and pleural surfaces were looking normal. The cyst was excised and the cavity was irrigated with hypertonic saline. A chest drain was left in the left pleural cavity. Postoperatively the patient had no complications.Bethadine diluted in normal saline was instilled into the pleural space via the chest drain for washing any remains of the infection. The drain was removed after 48hrs and the patient was discharged from the hospital on antiparasitic treatment (Albendazole tablets). Results: the patient had an uneventful recovery from surgery; he was reviewed in the clinic and had no evidence of recurrence of the disease. Histopathology report revealed laminated membranes with few protoscolices consistent with hydatid cyst (Eccinococcal infection). Conclusion : this is an unusual presentation of cystic echinococcosis (hydatid disease) which was excised robotically. Cystic Echinococcosis is a parasitic disease caused by infection with the larval stage of a tiny tapeworms of Echinococcus granulosus which usually grows in dogs (definitive host), sheep, cattle, goats, and pigs (intermediate hosts). Although most infections in humans are asymptomatic, hydatid disease can lead to the development of harmful, slowly enlarging cysts mainly in the liver and lungs. However, it might rarely affect other organs but it often remains unnoticed and neglected for years.