Echinococcus is a parasitic infection in humans that is endemic in livestock-raising regions. Cardiac echinococcosis accounts for 0.5%-2% of all hydatid disease cases.1 Since no effective medical treatment for cardiac cysts is currently available, surgical removal remains the standard treatment.2
A 58-year-old male patient was admitted to our clinic with chest pain persisting for one week. He lived in a rural village and had raised dogs and cows there since childhood. Physical examination was unremarkable. Electrocardiography revealed T-wave inversion in the anteroseptal leads, while laboratory results were within normal limits. Transthoracic echocardiography (TTE) demonstrated no systolic or diastolic dysfunction. Pericardial effusion was within physiological limits, and a non-specific calcified area was detected at the apex of the left ventricle (Figure 1a). With a preliminary diagnosis of unstable angina pectoris, the patient was hospitalized. Coronary angiography revealed non-obstructive coronary arteries but unexpectedly demonstrated a calcific structure at the left ventricular apex (Figure 1b). This calcification raised suspicion, promoting computed tomography (CT), which identified a smoothly contoured hypodense lesion measuring 3 × 2 cm with diffuse amorphous calcifications along the wall, located in the epicardial fat planes at the apical region of the left ventricle (Figure 1c). Additional CT scans of the abdomen and brain showed no hydatid cysts outside the cardiac region. Surgical excision of the lesion was planned. Albendazole therapy was initiated one month prior to surgery and was scheduled to continue for six months postoperatively. At surgery, an intramyocardial lesion approximately 4 cm in diameter was identified at the left ventricular apex and excised completely (Figure 1d). Pathological examination confirmed the diagnosis of a hydatid cyst. The postoperative course was uneventful. Follow-up echocardiography showed no pericardial effusion. The patient was discharged in stable condition, and no complications were observed during follow-up.
Cardiac hydatid cysts are rare and frequently asymptomatic in their early stages, making clinical suspicion crucial for diagnosis. Echocardiography and CT are the preferred diagnostic tools for evaluating cardiac masses.3 Familiarity with the imaging spectrum of hydatid cysts aids physicians in establishing timely and accurate diagnoses and in planning appropriate management.4 Cyst perforation is the most serious complication, leading to anaphylactic shock, thromboembolism, and death in approximately 75% of cases.1 In the literature, TTE is typically the initial test raising suspicion for cardiac hydatid cysts.5,6 In our case, however, suspicion first rose from the incidental finding of calcification on angiography, which led to the diagnosis. Moreover, previous reports have shown that cardiac hydatid cysts may cause sudden death.7,8 For this reason, even asymptomatic cases warrant surgical treatment.
Informed Consent: The informed consent form was provided by the patient to publish this case.
Authorship Contributions: Concept- F.K., C.T., M.G., A.R.; Design- F.K., C.T., M.G., A.R.; Supervision- M.G., A.R.; Data Collection or Processing- F.K., A.R.; Analysis and/or Interpretation- F.K.; Writing- F.K., C.T.; Critical Review- M.G., A.R.
Conflict of Interest: No conflict of interest was declared by the authors.
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