a 45-year - old male patient was admitted to an outpatient clinic with blunt thoracic trauma after falling from height ( work - related accident ) and was referred to kocaeli university faculty of medicine after the detection of ischemia on his electrocardiogram . in the physical examination ,
the vital signs were stable , but pain and tenderness was detected on his ribs in the thoracal examination .
however , it was worth noting the patient had a history of hypertension . a t inversion was detected in d1 , avl , and v3 , v4 , v5 , v6 derivations in the electrocardiogram ( ecg ) .
further , there were no additional pathologic findings in the blood tests and the serological tests
echocardiography showed minimal mitral insufficiency and a cystic lesion ( size : 2527 mm ) next to the left ventricle anterolateral wall ( fig .
cardiac magnetic resonance imaging ( mri ) documented a cystic lesion on the lateral wall of the left ventricle , approximately 3.52.5 cm in size ; this lesion was initially considered to be similar to a hydatid cyst ( fig .
1b ) . there were no additional cyst hydatid lesions found in the computerized tomography scan of the abdomen and the thorax .
median sternotomy was performed under general anesthesia , and cardiopulmonary bypass was initiated after standard aorta and bicaval cannulation .
the cyst was opened up ; cyst fluid was aspirated ; and the remaining contents , including the germinative membrane and the daughter vesicules , were removed ( fig .
we paid maximum attention to the prevention of the dissemination of the aspiration fluid to the pericardial sac .
the cyst cavity was irrigated with a highly concentrated sodium chloride solution , and then , the empty sac was closed with primary sutures .
a therapy with albendazole was initiated immediately with a 10-mg / kg / day dose and maintained for three months .
echocardiography and thorax computed tomography ( ct ) were repeated in the outpatient clinic control at 6 months postoperatively and showed no pathological findings .
median sternotomy was performed under general anesthesia , and cardiopulmonary bypass was initiated after standard aorta and bicaval cannulation .
the cyst was opened up ; cyst fluid was aspirated ; and the remaining contents , including the germinative membrane and the daughter vesicules , were removed ( fig .
we paid maximum attention to the prevention of the dissemination of the aspiration fluid to the pericardial sac .
the cyst cavity was irrigated with a highly concentrated sodium chloride solution , and then , the empty sac was closed with primary sutures .
a therapy with albendazole was initiated immediately with a 10-mg / kg / day dose and maintained for three months .
echocardiography and thorax computed tomography ( ct ) were repeated in the outpatient clinic control at 6 months postoperatively and showed no pathological findings .
hydatid disease is endemic in farming areas but occurs worldwide . in particular , the incidence is greater in the cattleor sheep - raising areas of the world , such as australia , south america , south africa , and panama , the mediterranean countries , and the middle east .
the most common site of the disease is the liver , followed by the lungs , kidney , bones , and brain .
. any race can be affected , and this disease is common in both men and women .
its symptoms depend on the affected organ ; for example , liver cysts cause jaundice and abdominal discomfort , while lung cysts cause cough , chest pain , and hemoptysis ( coughing up blood ) .
hydatid cyst is a human parasitic disease in which multiple - visceral involvement is generally caused by the metacestode of the tapeworm or larva of the species of the genus echinococcus .
however , the most frequently involved cardiac region is the left ventricle ; the right ventricle and the interventricular septum are the less affected regions , respectively .
the age of the cyst , size of the cyst , and the extent of calcification are decisive for clinical presentation in patients .
patients generally present at outpatient clinics with complaints of subjective symptoms such as palpitation , dyspnea , and atypical angina pectoris .
diagnosis is performed using imaging techniques , examination of the cyst fluid , and serological tests .
a cardiac cyst can lead to life - threatening consequences such as myocardial infarction caused by the compression of a coronary artery , pulmonary edema caused by a disturbance in the valvular mechanisms , or outflow tract obstruction and sudden cardiac arrest caused by a variety of conduction defects .
a cardiac cyst is a diagnostic and therapeutic challenge due to the variability of signs and symptoms at its presentation , its numerous and often unpredictable preoperative complications , and the risk of complications associated with cardiac surgery .
our patient was asymptomatic for years and did not have any complaints associated with hydatid disease before the accident when a cardiac hydatid cyst was diagnosed by the thorax ct .
arrhythmia , electrical conduction system defects and bundle branch blocks , myocardial infarction , and non - specific st segment and t - wave changes can be seen in the ecg in the cases of cardiac hydatid cysts .
a t inversion was detected in d1 , avl , and v3-v6 in the ecg of our patient ; however , the patient 's coronary angiography was normal .
cardiac cyst hydatid involves many septums and occasionally , daughter cysts . because of the thin membrane surrounding the cyst it can be distinguished from other intracardiac masses by echocardiography .
a hydatid cyst can be in the form of a solid mass or have a multiloculated cystic formation in some cases .
cardiac mri and thoracic ct have been utilized in the diagnosis of hydatid disease . in our case ,
the cardiac mri revealed normal intensities , sizes , and wall thicknesses of the right ventricle , left atrium , and right atrium .
further , a hypodense mass ( size : 3.52.5 cm ) was observed in the t1-weighted sequence ; the t1- and t2-weighted sequences of the cyst rim revealed hypointensity .
the most common treatment strategy of echinococcosis is 6 months of medical treatment with albendazole or mebendazole or a combination of albendazole and praziquantel after surgical treatment .
we chose surgical excision under cardiopulmonary bypass , and the albendazole treatment was pursued after surgical cyst excision in this patient .
the patient is still being followed in the outpatient clinic of infectious diseases . in conclusion ,
the possibility of cardiac hydatid disease should be kept in mind , particularly in the endemic zones . due to the high risk of their associated complications ,
 cardiac involvement in hydatid disease is more seldom than the involvement of the liver and the lungs . 
 cardiac cyst hydatid disease is diagnosed incidentally or by means of symptoms such as dyspnea and angina pectoris . here 
 , we present the case of a 45-year - old male patient who underwent open heart surgery for a randomly detected cardiac cyst hydatid during investigations carried out in a healthcare institution after accidentally falling from height . on the other hand 
 , this patient did not have any complaints associated with hydatid disease before this event . 