title: Echocardiography findings in 16 cases of cardiac echinococcosis: proposal for a new classification system.
abstract: BACKGROUND
  Echocardiography is a reliable method for diagnosing cardiac echinococcosis (CE). Currently, there is no echocardiographic classification system for CE, but such a scheme would facilitate diagnosis. This article presents echocardiographic data for 16 cases with CE and outlines a method for echocardiographic classification of CE based on the World Health Organization's ultrasonographic classification of cystic echinococcosis.
  
  
  METHODS
  We assessed the echocardiographic features of hydatid cysts in 16 patients with CE (9 women and 7 men; mean age, 41 +/- 18.3 years), all of whom underwent cardiac surgery. The proposed classification system identifies 3 types of CE lesions: active (unilocular or multilocular and echolucent, showing double-layered cyst wall and hydatid sand); transitional (shrunken as a result of reduced intracystic pressure, and showing water lily sign); and inactive (completely degenerated contents creating the ball-of-wool sign). Preoperative echocardiographic findings (lesion location, imaging appearance [unilocular/multilocular, solid/semisolid], echocardiographic classification/type, number of lesions) were compared with computed tomographic, intraoperative echocardiographic, surgical, and parasitological findings.
  
  
  RESULTS
  Preoperative echocardiography revealed 18 hydatid cysts (10 myocardial, 7 pericardial, 1 on the ascending aorta). In all, 10 lesions appeared multilocular, 6 unilocular, and 2 solid. A total of 11 were active, 5 transitional, and 2 inactive. Computed tomography identified 20 lesions total, therefore, two were missed on echocardiography. The preoperative echocardiographic findings correlated well with intraoperative echocardiographic, surgical, and parasitological findings.
  
  
  CONCLUSIONS
  The 3 types of CE lesions defined in this proposed classification system feature distinct echocardiographic characteristics. This new system is reliable and practical, and could assist with diagnosis and rapid treatment of CE.
authors.affiliation: Department of Cardiology, Cardiovascular Surgery, Yuksek Ihtisas Hospital, Ankara, Turkey. otufekcioglu@ttnet.net.tr
authors.forename: Omac
authors.initials: O
authors.lastname: Tufekcioglu
authors.forename: Cemal Levent
authors.initials: CL
authors.lastname: Birincioglu
authors.forename: Kemal
authors.initials: K
authors.lastname: Arda
authors.forename: Iyat
authors.initials: I
authors.lastname: Fansa
authors.forename: Ahmet
authors.initials: A
authors.lastname: Saritas
authors.forename: Mehmet
authors.initials: M
authors.lastname: Karahan
mesh_terms: D000328:Adult; D004443:Echinococcosis / Q000145:classification* / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D038801:International Classification of Diseases; D008297:Male; D009205:Myocarditis / Q000145:classification* / Q000000981:diagnostic imaging*