The stroke that unveiled a silent threat: rupture and thrombosis of hydatid cyst in the left ventricle- a case report.

BACKGROUND

Cardiac hydatid cysts are rare, even in endemic regions, and are typically asymptomatic. Systemic embolism resulting from rupture of a cardiac hydatid cyst is exceptionally uncommon, and thrombosis within a cyst has not previously been reported.

CASE PRESENTATION: We describe the case of a 7-year-old girl who presented with left hemiplegia and aphasia secondary to an ischemic stroke. Neuroimaging revealed a right middle cerebral artery infarction, while cardiac imaging identified a heterogeneous mass at the apex of the left ventricle. Further investigations confirmed a ruptured and partially thrombosed hydatid cyst. Additional infarctions in the spleen and kidneys supported a diagnosis of systemic embolization. Surgical management was performed via a left pleural approach due to pericardial adhesions. Cardiopulmonary bypass was established, and aortic cross-clamping was used to prevent embolization. A pre-declamping transverse aortotomy revealed and allowed removal of the germinative membrane. The patient recovered well postoperatively, with resolution of aphasia but persistent hemiplegia. Histopathology confirmed hydatid disease.

CONCLUSION

This case represents the first reported instance of a ruptured and thrombosed cardiac hydatid cyst causing systemic embolization. It underscores the critical role of intraoperative aortic inspection before declamping to prevent secondary embolic events.