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.

Journal of the American College of Cardiology Vol. 62, No. 16, 2013� 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00Published 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

25-year-old male presented with dyspnea of 6 months duration. Physical examination

Arevealed 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.