Журнал клинических случаев

Acute Right Atrial Collapse During Childbirth Due to Enormous Echinococcus Cyst of the Lungs

Abstract

Achilleas L, Maria T, Meletios K, Kleanthi-Christina A, Evaggelos B, Dimitra B and Konstantinos A

Introduction: Hydatid disease usually affects the liver and lungs. Pulmonary disease is usually asymptomatic until the cyst enlarges sufficiently to compress other organs or erupts releasing a large amount of antigenic material.
Case report: An 18-year-old female patient was submitted to the emergency department fifteen days postpartum presenting fatigue, breathlessness and non-productive coughing. According to the patient’s description, symptoms first appeared two months ago displaying great aggravation for the past two weeks, along with episodes of conscious loss and eyesight loss during the last 24 hours. Imaging findings revealed a large cystic mass, 15 × 11 × 13 cm in size, occupying the right middle and lower chest cavity. The mass seemed to be in contact with the pericardium pressing onto the right atrium’s wall, the diaphragm and the right lung. A right thoracotomy was performed which revealed a big Echinococcus cyst full of serous fluid that occupied half of the right chest cavity’s volume.
Discussion: The extrinsic compression of the right atrium by an extracardiac mass has been very rarely reported in literature. In our case, the mass compressing the right atrium of the heart was an undiagnosed pulmonary hydatid cyst. Systematic realignments during natural childbirth, the size of the uterus, the widely used Valsalva pushing technique decrease venous return to the heart, diastolic filling and stroke volume. These changes deteriorate the operation of an already strained right atrium leading to a collapse of peripheral arterial pressure. The patient experienced symptoms of low blood pressure and lung compression, demanding urgent surgical operation for the removal of the cyst.
Conclusion: This is a rare case of a patient with pulmonary hydatid disease where the Echinococcus cyst compressed the right atrium’s wall. The heart’s strain deteriorated due to the patient’s pregnancy and childbirth, a clinical course leading to the need of urgent and immediate action.