Journal of the American College of Cardiology Vol. 62, No.

16, 2013
Ó 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00
Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.04.103

IMAGES IN CARDIOLOGY

Giant Cardiac Hydatid Cyst

An Uncommon Cause of Cardiomegaly
Nagaraja Moorthy, DM,* Rajiv Ananthakrishna, DM,* Ravindran Rajendran, MD,*
Girish S. L. Gowda, MCH,y Seetharama P. S. Bhat, MCH,y Manjunath C. Nanjappa, DM*
Bangalore, India

From the *Department of
Cardiology, Sri Jayadeva
Institute of Cardiovascular
Sciences & Research,
Bangalore, India; and the
yDepartment of Cardiothoracic
and Vascular Surgery, Sri
Jayadeva Institute of
Cardiovascular Sciences &
Research, Bangalore, India.
Manuscript received
April 8, 2013;
accepted April 19, 2013.
25-year-old male presented with dyspnea of 6 months duration. Physical examination
A revealed muffled heart sounds. Electrocardiogram was normal. Chest x-ray in postero-
anterior view showed cardiomegaly and upturned apex (A). In the lateral view, a dense
well demarcated opacity (arrow) was seen between cardia and dome of diaphragm (B). Trans-
thoracic and transesophageal echocardiography revealed multiple cysts in the usual cardiac loca-
tion, giving a honeycomb appearance (C, Online Video 1) and suggestive of hydatid cyst. The
cardiac chambers could not be visualized on echocardiography. Cardiac magnetic resonance
imaging revealed a giant hydatid cyst with multiple daughter cysts within it, occupying intra-
pericardial space with marked cephalad and posterolateral displacement of cardiac chambers
(D and E; Online Videos 2 and 3). The cyst measured 10  11  12 cm. During surgery,
more than 200 daughter cysts were removed along with debris (F). Pericardial involvement in
hydatid cyst disease is rare. We highlight intrapericardial echinococcosis presenting as
cardiomegaly on chest radiograph.