[Phreno-mediastinal hydatidosis and cysto-aortic fistula with multiple systemic embolism]

We present a 52-year-old patient who came to the emergency room with non-specific symptoms and whose clinical profile after 24 hours included acute abdomen and paresthesia in both lower extremities. A chest film revealed mediastinic enlargement; embolism was suspected. During surgery intestinal ischemia was found in the superior mesenteric artery; this was resected and termino-terminal anastomosis was accomplished with the remaining jejunum and the descending colon. At the same time, some flaccid vesicles were removed along with embolis in the femoral arteries, leading to suspicion of hydatid embolism. Transthoracic and transesophageal echocardiography showed multivessicular masses with internal blood flow in the posterior-inferior mediastinum, suggestive a ruptured hydatid cyst in the thoracic aorta. This was confirmed by thoracic-abdominal computed tomography. The patient's condition worsened, with acute renal failure, ischemia, necrosis of both legs and multiorgan failure leading to death. We discuss the rarity of this case, the use of imaging tools for diagnosis, and the inexorability of the disease in spite of treatment.