Echinococcosis is a protozoal infection usually affecting people living in rural, sheep-raising areas. Although it is currently rare in developed Western countries, globalization, increasing travel opportunities and migrations harbor the potential to raise its prevalence. Infection most commonly affects the liver and lungs (70 and 20% of cases, respectively). Cardiac involvement is observed in less than 2% of cases, with the primary infection of the heart being extremely rare (< 0.2%) [
1]. It can be found in any part of the myocardium, but it is most commonly located in the free wall of the left ventricle (LV). Interventricular septal (IVS) involvement is observed in 4% of cases [
2]. Most patients are asymptomatic. Dyspnea, palpitations and chest pain [
3] occur in a minority of patients. The preferred management option remains complete surgical excision, due to the risk of cyst rupture. The latter is associated with a high mortality risk, secondary to acute pulmonary hypertension, peripheral embolization and anaphylactic reactions [
4]. The cornerstones of medical therapy are albendazole and praziquantel. A typical diagnostic algorithm includes echocardiography and computed tomography or cardiac magnetic resonance (CMR) [
5]. Although ultrasound is a cornerstone of diagnosis, magnetic resonance with heavily T2-weihgted series is preferable to computed tomography for extrahepatic echinococcosis [
6]. Either way, imaging is used to classify lesions into six types, which define three stages of the disease; active, transitional and inactive [
7]. Management options are affected by disease staging, as inactive cysts have the lowest chance of rupture [
8]. Most often, after imaging, serology testing (Western blot and enzyme-linked immunosorbent assay) is performed to confirm the diagnosis. Definitive confirmation is based on pathohistological examination of intraoperative specimens.
The aim of this case report is to present successful staged management approach in the treatment of a giant hydatid cyst, in which medical therapy led to cyst degradation, enabling surgical excision.