Intramyocardial hydatid cyst: a case report
The following case has been reported in the European Heart Journal Case Reports of A 52-year-old female patient presented with complaints of increasing retrosternal chest discomfort and dyspnoea on exertion since 3 months. Her physical examination was unremarkable. On evaluation, the heart rate, rhythm, and jugular venous pressure were normal. Auscultation findings were also unremarkable.

Haematological and biochemical parameters were within normal limits. Electrocardiography (ECG) revealed no abnormal findings. X-ray and echocardiography were advised for routine workup following which cardiac magnetic resonance imaging (MRI) was advised for detailed evaluation. The posteroanterior chest X-ray revealed a well-defined, lobulated, homogenous radiopaque lesion in left paracardiac mid-zone silhouetting with left heart border.

Parasternal long-axis view on echocardiography showed multiseptated anechoic lesion adjacent to left ventricle causing luminal compromise suggestive of hydatid cyst likely within the interventricular septum and left ventricular wall. Short-axis view on echocardiography showed multiseptate anechoic lesion arising from left ventricular wall suggestive of intramyocardial hydatid cyst.

Apical view on echocardiography of the four chambers of the heart showed hydatid cyst arising from interventricular septum, and left ventricular wall causing narrowing of left ventricular lumen.

Two-dimensional echocardiography showed multiple echo free cystic spaces around pericardium compressing right and left ventricles. Pre-contrast T1- and T2-weighted black blood images on cardiac MRI showed large multivesicular and septated, cystic (T2 hyperintense) lesion with water content (low signal on T1; high signal on T2) in the interventricular septum extending into anterior wall (giving wheel like appearance) suggesting intramyocardial hydatid cyst.

The patient was taken up for cardiac surgery and after successful excision is now following up on albendazole treatment. Pathology of the resected specimen (hydatid cyst) showed laminated membrane on 10× and 40× haematoxylin and eosin magnification. Post-operative chest X-ray showed resolution of lesion. The patient was asymptomatic in the 7-month follow-up period following surgery.

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