Echinococcosis of the Heart and Ascending Aorta

A 35-year-old woman with a history of disseminated thoracic echinococcosis treated by resection of an intraventricular septal cyst 11 years earlier in her country of origin presented for the first time to our cardiology outpatient clinic with atypical chest pain and shortness of breath. Transthoracic echocardiography revealed multiple masses in the pericardium (Figure 1); chest x-ray showed widening of the right middle mediastinum (Figure 2). Computed tomography imaging and T2-weighted turbo spin echo were performed and confirmed the infiltration of the pericardium by multiple cysts (Figure 3). In addition, a saccular aortic pseudoaneurysm of the ascending aorta (Figures 4 and 5) was revealed and confirmed by aortography (Figure 6 and Movie I in the online-only Data Supplement). We hypothesized that the pseudoaneurysm developed subsequently to fistulization and rupture of a hydatid cyst into the aorta. Indeed, the patient reported having presented an anaphylactic shock several months earlier while living abroad. Given the potential risk of rupture of the aortic pseudoaneurysm, we referred the patient to redo surgery