A Unique Case of Pulmonary Valve Direct Involvement in Multiple Cardiac Localization of Hydatid Cysts.

A 68-year-old man was admitted to the emergency room for chest pain. He presented normal vital signs and high values of D-dimer. First, he was evaluated with a computed tomography which revealed a mass attached to the pulmonary valve (PV), initially labeled as a thrombus (Figure 1). The transthoracic echocardiography and then transesophageal echocardiography confirmed the presence of the mass, showing findings that instead suggested the cystic nature of it (Figure 2). A cardiac magnetic resonance imaging was performed. Again, a mass attached to the ventricular side of the PV was confirmed. Also, the cystic nature of the mass was confirmed (Figure 3). Furthermore, in the steady state free precession sequences, the cyst appeared to contain another small cyst structure, a daughter cyst, representing a pathognomonic feature of the hydatid cysts (Figure 4). The other 2 cysts were detected intramyocardially at the ventricular septum and the left ventricular inferior wall. Later on, the patient confirmed that an echinococcal infection had occurred 20 years earlier.