Abstract

Cardiac hydatid disease is rare but may lead to life-threatening complications such as rupture, pericardial effusion, tamponade, and anaphylaxis. Pericardial involvement is particularly uncommon and may mimic acute coronary syndrome (ACS). A 62-year-old man presented with chest pain. The electrocardiogram showed T-wave inversions in leads D1, D2, aVL, aVF, and V4-V6. Cardiac biomarkers were elevated (CK-MB 91 ng/mL; hs-troponin T 311 pg/mL), and coronary angiography was performed with a presumptive diagnosis of ACS; no obstructive coronary lesion was detected and TIMI 3 flow was preserved. During hospitalization, the patient developed dyspnea. Transthoracic echocardiography revealed pericardial effusion and a mass-like intramyocardial appearance in the apicolateral left ventricle; lesion characterization was limited. Coronary computed tomography angiography demonstrated a cystic lesion with internal membranous structures at the apical anterior and lateral walls of the left ventricle, consistent with a Gharbi type 2 hydatid cyst, along with marked pericardial effusion. Indirect hemagglutination test was positive at 1/2560, and albendazole therapy was initiated. Surgical excision was successfully performed on day 15, and the patient was discharged without complications. This case highlights that hydatid disease should be considered in the differential diagnosis of ACS-like presentations with elevated troponin, non-obstructive coronary arteries, and pericardial effusion in endemic regions.