Isolated Cardiac Hydatid Disease Presenting as Ventricular Remodeling and Tamponade

BACKGROUND: Cardiac hydatid (echinococcal) disease is rare, and presentation with cardiac tamponade and secondary myocardial remodeling is exceptional. CASE SUMMARY: A 16-year-old woman presented with acute pleuritic chest pain on a background of progressive dyspnea. Multimodality imaging revealed a large intact pericardial hydatid cyst with adjacent myocardial thinning, concentric hypertrophy of the uninvolved left ventricular segments, active pericarditis, and pericardial effusion with tamponade physiology. Intraoperatively, a large intact hydatid cyst was identified along with free-floating laminated membranes within the pericardial space, several of which were adherent to the epicardium, suggesting rupture of an additional occult cyst, likely of myocardial origin. Surgical excision led to complete symptom resolution. Cardiac magnetic resonance imaging and genetic testing excluded primary cardiomyopathies. DISCUSSION: Isolated cardiac echinococcosis is rare, with myocardial involvement responsible for most clinically significant presentations. Although the cysts usually grow slowly and present insidiously, acute symptoms may arise owing to complications such as cyst rupture or pericardial inflammation. Chronic cyst expansion may induce secondary myocardial remodeling, including left ventricular hypertrophy, and predispose to tamponade physiology. TAKE-HOME MESSAGE: This case illustrates a rare presentation of cardiac hydatid disease complicated by secondary myocardial remodeling, pericarditis, and cardiac tamponade.