We present the case of a 48-year-old man who presented to the emergency department with palpitations and drowsiness. Vital signs: blood pressure 80/50 mmHg, heart rate 112 b.p.m., and O2 saturation 92% on the right atrium. He was diagnosed with sustained ventricular tachycardia and was promptly cardioverted (Panel A). The patient underwent a multi-modality diagnostic assessment, the final diagnosis of cardiac echinococcosis was made, and the patient underwent surgical treatment. In the follow-up, the patient is stable receiving medical treatment. No new arrhythmic episode was recorded during the post-surgical follow-up, thus the patient was not considered a candidate for an intracardiac defibrillator.
The objective of this flashlight is to showcase the imaging findings of this exceptionally rare disease. Bidimensional and colour Doppler transthoracic echocardiography apical four-chamber view (Panel B), showed mild tricuspid regurgitation (arrow), and a heterogeneous mass that occupies around 50% of the right ventricular cavity (yellow arrows) and expels the left ventricle compromising its size. Contrasted computed tomography (Panel C, rotated to match the echocardiographic view), a well-delineated, giant rounded echogenic mass that infiltrates the right ventricle (arrow) with compression of the interventricular septum to the left and occupies a great proportion of the right ventricle. Computed tomography 3D rendering of the heart before (Panel D) and after (Panel E) surgery, the mass was completely removed. Microscopic exam of the cyst with haematoxylin-eosin staining (Panel F), with visualization of cyst wall composed of a fibrous laminated layer with an inner germinal layer with broad capsule and scolices surrounded by a fibrous capsule. Most patients with cardiac echinococcosis are asymptomatic. The exact prevalence of cardiac involvement in human hydatidosis is unknown, but estimations range from 0.5% to 2%. There is a long period of time between parasitic infection and clinical manifestations, hence this disease is often discovered incidentally. Echocardiography is the initial modality for the diagnosis. Computed tomography scans and magnetic resonance imaging provide a detailed characterization of the cysts. Surgical excision is performed in most cases with a high rate of complete recovery.
Consent: The authors confirm that written consent for submission and publication of this case report including images and associated text has been obtained from the patient in line with COPE guidance.
Conflict of interest: None declared.
Funding: None declared.