Cardiac Hydatid Cyst in a 17-Year-Old Patient: Diagnostic Role of Cardiac Magnetic Resonance

Description of Clinical Presentation: A 17-year-old male with no prior cardiovascular history presented to the emergency department with community-acquired pneumonia. His ECG was normal, and chest X-ray showed a suspicious opacity. CT confirmed pulmonary consolidation consistent with pneumonia, but also revealed an intramural cystic lesion in the lateral wall of the left ventricle (LV). He was subsequently referred to cardiology for outpatient evaluation.

Diagnostic Techniques and Their Most Important Findings: Cardiac magnetic resonance (CMR) demonstrated a normal LV wall thickness with impaired contraction of the basal inferolateral and inferior segment and a mildly reduced systolic function. On steady state free precession (SSFP) cine sequences, an intramural cyst (48 × 50 × 40 mm) was identified in the basal inferolateral and inferior LV segment. The lesion appeared hypointense on T1-weighted and hyperintense on T2-weighted imaging, with a thin hyperintense rim on post-contrast T1-weighted sequences. No enhancement was seen on first-pass perfusion, but a hyperintense ring around the cyst was evident on late gadolinium enhancement imaging.
Differential diagnosis included foregut duplication cyst and hydatid cyst. Given the endemic setting for echinococcosis, hydatid disease was strongly suspected despite negative serology. The case was discussed in a multidisciplinary team meeting, and surgical excision was recommended. Histopathology confirmed Echinococcus spp. by demonstrating characteristic hooks.

Learning Points from this Case:

• Echinococcosis is a parasitic infection caused by the larval stage of Echinococcus spp. The liver and lungs are the most frequently affected organs; cardiac involvement is rare (0.5–2%).


• Cardiac hydatid cysts grow slowly and are often asymptomatic until expansion leads to coronary compression, arrhythmias, valvular dysfunction, or ventricular impairment.


• Serological tests have limited sensitivity; therefore, imaging is essential for diagnosis. CMR is particularly useful due to its multiplanar capability, superior tissue characterization, and absence of ionizing radiation.


• Surgery, combined with perioperative albendazole therapy, remains the treatment of choice.

CT: hypodense cyst on basal inferolateral & inferior segment of the LV.
T2-weighted (a) and PSIR (b) imaging SAX: hyperintense cyst and hyperintense (LGE) ring respectively
Open cyst during surgery (a). Mycroscopy: Echinococcus hooks and fibrin (b)