Durmaz, Fatma Kurt, Ferhat Özgökçe, Mesut
Hydatid disease, caused by Echinococcus granulosus, rarely affects the heart, with less than 2% of cases involving cardiac structures1. A 24-year-old man was evaluated for a suspected cardiac mass during a routine examinations for carnitine deficiency. Initial chest radiography revealed a radiopaque area in the right lung and a lobulated contour on the left side of the heart (Figure 1A). Noncontrast chest computed tomography (CT) confirmed a well-defined cystic lesion in the right lung and a focal hypodense area in the left ventricular wall (Figure 1B). Echocardiography performed eight months prior was normal, and serological tests for Echinococcus were negative. Cardiac magnetic resonance (CMR) imaging revealed a 26×20 mm lesion in the mid-ventricular anterior wall of the left ventricle that was hyperintense on T2-weighted images (Figure 1C) and hypointense on T1-weighted images (Figure 1D). The lesion showed an increased relaxation time on T1 mapping (Figure 1E) and a relatively thick wall. Early first-pass perfusion CMR indicated low signal intensity with minimal perfusion. Late gadolinium enhancement CMR revealed peripheral enhancement without internal enhancement (Figure 1F). These findings led to a diagnosis of cardiac and pulmonary hydatid cysts, which were confirmed by surgical intervention.
FIGURE 1:
Multimodal imaging of the cardiac hydatid cyst case. A) Chest radiograph showing a radiopaque lesion in the right lung (yellow arrow) and bulging of the left cardiac contour. B) Axial non-contrast computed tomography demonstrating a cystic lesion in the right lung (green arrow) and a hypoattenuating area in the left ventricular wall. C) T2-weighted coronal magnetic resonance (MR) image showing hyperintensity of the lesion in the left ventricular wall (arrowhead). D) T1-weighted short-axis MR image displaying the hypointensity of the same lesion (arrow). E) T1-mapping MR showing prolonged relaxation time. F) Post-contrast cardiac MR demonstrating ring-like enhancement indicative of pericystic fibrotic content.
CMR provided detailed insights into lesion morphology and tissue characterization, which are crucial for surgical planning2. Owing to the fibrous pericyst content, the peripheral wall of the cyst showed ring enhancement on delayed contrast-enhanced images3.
Cardiac echinococcosis should be considered in the differential diagnosis of cystic cardiac lesions. CMR is an essential diagnostic tool for accurate assessments and preoperative planning.
