CARDIAC 'BALL OF WOOL': A rare case of a solid interventricular hydatid cyst

A 49 years old Romanian lady was admitted to the department of infectious diseases because of dyspnoea, malaise and mild fever. Chest X-ray was normal. A 12 lead ECG demonstrated right bundle branch block, and a transthoracic echocardiography showed a mass in the mid inter-ventricular septum, measuring 40x25 mm, protruding into the right ventricular chamber. The mass had the appearance of a solid lesion iso-echoic with the myocardium with hypo-echoic zones inside, resembling a “ball of wool” (Figure 1), suggesting a myxoma. Otherwise, all echocardiographic parameters were normal, except a mild pulmonary hypertension (PAPs 35 mmHg). During laboratory investigations, serum antiechinococcus antibodies was positive. Various imaging investigations including CT scanning and echocardiography were undertaken, but no cysts were detected in the abdomen or chest, respectively. The cardiac mass was then studied in more detail: a three-dimensional echocardiography was performed to better appreciate the shape and the location of the mass for a cardio-surgical view (Figure 2). A cardiac magnetic resonance didn’t show specific features and indicated a probable tumour, such as echocardiography (Figure 3).