Voluminous calcified pericardial cyst with severe right ventricular compression: a multimodality imaging case report

Background: Pericardial cysts are rare lesions that are typically asymptomatic. However, when large or calcified, they may compromise cardiac function. Case summary: We report the case of a 57-year-old man with progressive exertional dyspnoea. Multimodality imaging revealed a large calcified pericardial cyst causing significant right ventricular compression and interventricular dependence. Given his history of prolonged residence in Central America, a parasitic aetiology was suspected. Surgical drainage with partial resection was performed under cardiopulmonary bypass. Histology confirmed a parasitic process. Postoperative recovery was uneventful, and the patient was discharged on antiparasitic therapy with full clinical resolution. Discussion: This case underscores the crucial role of multimodality imaging in the assessment of unusual pericardial disease and highlights the importance of considering parasitic aetiologies in patients with relevant epidemiological risk factors.