The cardiac localization of human echinococcosis is rare and little known 1234. It is exceptionally primary and isolated; classically integrating into a chart of thoracic involvement with associated pulmonary localization or of more diffuse form with multi-visceral involvement 1234. Primary forms of cardiac hydatid cyst (HC) account for only 0.5 to 2% of all human hydatid disease 56.

Cardiac hydatidosis is a condition characterized by its long functional tolerance and its clinical and para-clinical polymorphism, thus representing a real diagnostic and therapeutic challenge that is sometimes difficult to resolve 345678.It is particularly serious and severe because of its possible complications: acute pericarditis 8, tamponade 9, arrhythmia 10, infarction 11, pulmonary embolism 1213, cardiac arrest , and sudden death 14.

Myocardial ischemia remains an exceptional and unusual manifestation of this parasitosis 11. We report the original observation of cardiac HC revealed by acute myocardial ischemia in a young subject.

The primary cardiac localization of HC represent only 0.5 to 2% of all human hydatid disease 56, and the left cardiac cavities are less frequently affected than the right ones because of the thickness of their myocardium and their less vascularized nature. In contrast, and because of the thinness of the muscular wall and the low pressure regime in the right cavities, the latter represent the preferred seat of cardiac echinococcosis 1516. In these cavities, the HC is often superficial (under-endocardial development), which explains the important frequency of his endocavitary rupture compared with that of the left ventricle 17.

The cardiac localization of the HC is characterized by its important clinical polymorphism; the most common symptoms are precordialgia and dyspnea 151618. More rarely, it may be palpitations, haemoptysis, signs of right heart failure, pseudo-anginal acute pain often medio-thoracic and sometimes retro-sternal in relation with ischemia of the right ventricle 151618. Exceptionally cardiac HC may cause syncope 19 or congestive heart disease 20. In most cases, cardiac HC remains totally asymptomatic 2122.

This localization is also characterized by its gravity: the cardiac localization of the HC is potentially serious and even if the spontaneous involution and calcification is possible, the ultimatum of this localization remains ineluctably the death 123. This severity is mainly due to acute cardiac complications, often fatal; which are: pulmonary embolism 1213, acute pericarditis 82324, endocavitary rupture with anaphylactic shock, massive embolism or blockage of a valvular orifice 14.

Localized myocardial ischemia remains an exceptional acute complication during cardiac HC 23; this ischemia is of compressive origin due to the endo-myocardial development of the cyst which hinders the intra-myocardial coronary vascularization.

Apart from complicated cysts, the diagnosis of the cardiac HC represents a real challenge for the clinician because of the absence of specific clinical and electrical signs; medical imaging is very helpful in this context 2122.

On the electrocardiogram, signs of myocardial necrosis may be due to thinning of the myocardial layers surrounding the cyst, or secondary to obstruction of the coronary vessels by daughter vesicles 11; a true necrotic Q wave can also be seen 1123.

Echocardiography (trans-thoracic and/or trans-oesophageal) remains the test of choice for the positive diagnosis of cardiac HC 18. It makes it possible to specify the seat of the cyst at the level of the heart and its relation with the adjacent structures as well as its repercussion on the cardiac cavities 1825. The cardiac HC is often unique 21 and more rarely multiple 16.

Cardiac imaging in section (cardiac and cardio-thoracic CT and/or MRI) is useful to provide more information on the locoregional extension of cardiac echinococcosis and to search other intra- and extra-cardiac localizations 118. MRI is the method of choice for the exploration of cardiac, vascular and parenchymal lesions providing a complete lesion assessment before cardiac surgery; it has a good sensitivity and allows the diagnosis of small cysts 18.

Surgery is the standard treatment for cardiac hydatidosis 1516181925. The medical treatment based on benzimidazole derivatives is indicated alone in disseminated and inoperable cysts or if contraindications to surgery. It is also prescribed intra-operatively to reduce the risk of secondary dissemination and posto-peratively to prevent recurrence 1825.