Recurrent cardiac hydatid cysts with pericardial protrusion; a rare case presentation of Echinococcus granulosus

Hydatid cyst (HC) is a rare pathology mostly found in less developed, livestock-raising countries. HC can be found anywhere in the body, however it is a rare finding in the heart, and its recurrence in the heart and pericardium is very rare. A 54-year-old woman who had undergone surgery for the removal of HC in another country 11 years before presented with shortness of breath and heaviness in the chest. The examinations and computerized tomography (CT) scan revealed a large mass measuring 60×50 mm in the pericardium cavity originating from the right atrial wall. Infection with Echinococcus granulosus was confirmed with serological enzyme-linked immunosorbent assay (ELISA) test and the patient underwent cardiac surgery. The patient underwent cardiopulmonary bypass, nevertheless did not suffer cardiac arrest, and aortic cross-clamping was not performed for her. The removed mass was filled with daughter cysts. The endocysts were removed and intramural cysts were drained. Following the surgery, the patient received treatment with albendazole for six months. Cardiac hydatid cyst recurrence is a rare but possible incident, and annual follow-ups and echocardiography are recommended.