PMC8217688_01
A: EKG showing an ST elevation in DI, AVL and ST depression in inferior leads. B: TTE revealing a large multiloculated pericardial cyst adjacent to the lateral wall of the left ventricle. C: Coronary angiography showing a severe stenosis in the LAD artery. D: Chest X-ray showing a cardiomegaly with convex left middle arch. E: Thoraco-abdominal CT scan confirming the presence of a multivesicular pericardial cyst compressing and repressing the trunk of the pulmonary artery, the left ventricle and the LAD artery, as well as a second mediastinal cyst developing at the left cardiophrenic angle. F: Per-operative exploration showing a large hydatid cyst.
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The electrocardiogram showed ST elevation in DI, AVL and ST depression in inferior leads (Fig. 1-A). Transthoracic echocardiography (TTE) revealed a large multiloculated pericardial cyst measuring 9cm x 6cm, adjacent to the lateral wall of the left ventricle, suggesting a type 3 hydatid cyst (Fig. 1-B). The coronary angiography revealed severe stenosis in the mid left anterior descending (LAD) artery (Fig. 1-C). The hydatid cyst extension evaluation was performed to discuss the therapeutic approach and the revascularization modalities. The patient's chest X-ray showed no lung parenchymal abnormality, cardiomegaly with convex left middle arch (Fig. 1-D). Thoraco-abdominal computed tomography (CT) imaging, performed to further characterize the lesion, confirmed the presence of a multivesicular pericardial cyst compressing and repressing the trunk of the pulmonary artery, the left ventricle and the LAD artery, as well as a second mediastinal cyst developing at the left cardiophrenic angle (Fig. 1-E). The cyst was sterilized by injection of hypertonic saline solution, then the cystic material was aspirated, a partial peri-cystectomy was performed and the cavity was closed (Fig. 1-F).