Cardiac compression by a large pericardial cyst in hydatidosis

Pericardial hydatidosis is exceptionally rare. However, it can lead to cardiac tamponade or anaphylaxis. A 36-year-old farmer presented with chest tightness and dyspnea. Multimodality imaging illustrated a large, heterogeneous, avascular cystic mass within the pericardium adjacent to the right atrium and ventricle, causing significant compression and deformation of these chambers. Elective surgery was performed under transesophageal echocardiographic guidance to ensure precise resection of the cardiac echinococcal lesion and effective reduction of residual pathology. The postoperative course was favorable. A high index of suspicion is required for patients with a pericardial mass who originate from endemic regions or have a history of animal contact. The size and location of the cyst and the presence of complications determine the clinical presentation. Diagnosis is mainly based on cardiac imaging techniques. Surgical excision is the best treatment method for pericardial cystic echinococcosis. Intraoperative transesophageal echocardiography may serve as a valuable adjunct tool.