Right Ventricular Hydatid Cyst: A Rare Cause of Right Heart Failure in Pregnancy

Cardiac hydatid cyst is a rare manifestation of Echinococcus granulosus infection, comprising fewer than 2% of all echinococcosis cases. Right ventricular (RV) involvement causing right heart failure is exceptionally uncommon.

A 32-year-old woman at 29 weeks of gestation with a history of pulmonary tuberculosis presented with exertional dyspnea and bilateral pedal edema for 3 months. Investigations revealed peripheral eosinophilia and elevated N-terminal pro-brain natriuretic peptide. Transthoracic echocardiography demonstrated right atrial and ventricular dilatation with a large cystic mass arising from the RV free wall. Cardiac Magnetic resonance imaging confirmed a multiloculated cystic mass with peripheral daughter cysts, with concomitant pericardial, pulmonary, and hepatic cysts, establishing the diagnosis of disseminated echinococcosis.

RV hydatid cyst is a rare but treatable etiology of right heart failure that poses unique diagnostic and therapeutic challenges during pregnancy. This case underscores the importance of considering parasitic etiologies in endemic regions and demonstrates the feasibility of medical management as a temporary strategy during gestation.

Cardiac hydatid cyst should be considered in the differential diagnosis of unexplained right heart failure in patients from endemic regions. Peripheral eosinophilia and characteristic multiloculated cystic morphology on imaging are key diagnostic clues.