Imaging findings of fatal embolic hemorrhagic stroke secondary to right ventricular hydatid cyst: A case report

Abstract

Cystic echinococcosis (CE) is a zoonotic infection caused by Echinococcus granulosus, primarily involving the liver and lungs. Cardiac involvement is rare (0.5-2 of cases), and cerebral complications from cardiac CE are exceptionally uncommon but often fatal. A 19-year-old Afghan male with significant zoonotic exposures presented with progressive left flank pain, fever, nausea, and vomiting. Laboratory studies revealed elevated liver enzymes and thrombocytopenia. Thoracoabdominal computed tomography (CT) demonstrated a multiseptate hepatic hydatid cyst in segment III, and unexpectedly revealed a concomitant cardiac hydatid cyst in the right ventricle, which was further characterized by transthoracic echocardiography. The patient was scheduled for cardiac surgery and initiated on preoperative albendazole. However, hours before the procedure, he acutely developed right-sided hemiparesis and loss of consciousness. Emergent brain CT revealed an intracerebral hemorrhage (ICH) in the left middle cerebral artery (MCA) territory with intraventricular extension. Despite external ventricular drain placement, the patient died shortly thereafter. This case represents a rare fatal outcome of cardiac CE originating in the right ventricle, where cerebral embolization was the probable cause of the left MCA territory ICH. It underscores the critical need for high clinical suspicion of cardiac involvement in all CE patients and emphasizes the urgency of early surgical intervention to prevent catastrophic neurological sequelae.