Segmental portal hypertension due to a splenic Echinococcus cyst.

A 60-year-old Libyan woman developed perihilar splenic varices without other signs of portal hypertension. Plain abdominal X-ray examination showed two calcified structures in the left and right hypochondria. Ultrasound examination disclosed a 3-cm diameter, globally calcified hydatid cyst lodged in a critical location at the hilar region of the spleen. The cyst was compressing the hilar vessels which resulted in dilatation and varix formation. Another hydatid cyst measuring 5 cm in diameter, with extensive wall calcification was visualized in the right lobe of the liver. The splenic size was within normal limits. The liver revealed normal texture and size and the portal vein was of normal caliber. The patient underwent an uneventful splenectomy and was well at discharge.

Intracavitary cardiac hydatid cyst and the wall sign criteria.

Cardiac hydatid is rare at any age, accounting for less than 2% of all hydatid disease. The case is discussed of a 48-year-old female with a cardiac hydatid cyst attached intracavitary in the posterior wall of the right atrium. The Echinococcus cyst grows very slowly and, unless located in a critical anatomic site, it takes many years to evolve. Since the introduction of two-dimensional echocardiography, more cases are being diagnosed. The cyst was discovered incidentally by X-ray computed tomography and confirmed by trans-oesophageal echocardiography utilizing the wall-sign criteria developed by the authors. The cyst was removed surgically and the patient recovered by medical therapy.