Acute heart failure and a pseudo cystic image in the left ventricle

The association between acute heart failure (AHF) and cardiac tumor may change the short and long term management of both conditions. A 51-year-old man presented with signs of AHF. ECG showed sinus tachycardia and left ventricular (LV) hypertrophy. Chest x-Ray found dilated heart and pulmonary congestion. There were no significant changes in blood tests. Transthoracic echocardiography revealed chambers dilation, and LV ejection fraction (LVEF) of 17%. Unexpectedly, we found an apical 2/2 cm cystic image in the LV. This had a myocardium-like membrane, seen better in 3D echocardiography, suggestive for hydatic cyst. Cerebral, thoracic, and abdomino-pelvic CT scan showed no hydatic lesions. Anti-Echinococcus antibodies were negative. Initially the clinical challenge was the management of the tumor in a patient with AHF and dilated cardiomyopathy. He was treated for AHF and followed up for the cystic image. He exhibited significant improvement of the clinical status and LVEF (increased to 42 %), with important cardiac reverse remodeling. Surprisingly, the apical cystic image disappeared. However, we found a hypertrophic aberrant cordae from apex to mid-septum, in the same position as the previous image. Thus, we believe that this cordae, by important remodeling and torsion generated the cystic image. This case highlights the importance of serial 2D and 3D echo examinations in patients with severely remodeled LV, and also with tumoral images.