[A very uncommon reason for chest pain]

A 25-year old female immigrant from Kosovo living in Switzerland for three years complained of intermittent atypical chest pain and shortness of breath for three months. The patient was febrile (38.4 °C) and had a regular tachycardia of 120/min and a blood pressure of 105/65 mmHg. The ECG showed deep symmetric negative T-waves on the leads V1 - V6. The conventional chest X-ray revealed a small bulge of the left cardiac outline. Leucocytes and differential count were normal but the C-reactive protein was markedly elevated (118mg/L). Computed tomography of the chest revealed several pleural and paramediastinal cystic masses on the left side. One of these cystic lesions covered a small defect of the aortic wall appearing as a pseudoaneurysm at the beginning of the descending aorta. Echocardiography showed pericardial cysts on the left ventricle and a small pericardial effusion. Serological tests for Echinococcus granulosus were strongly positive. Thus, the patient was diagnosed with cystic echinococcosis with pericardial, pleural and mediastinal involvement with a pseudoaneurysm of the descending aorta.