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An 18-year-old male was referred to us for chest discomfort. A physical examination showed normal findings. The chest X-ray was also normal. ECG showed sinus rhythm and ischaemic changes in apico-infero-posterior myocardium. Two-dimensional-TTE (2DTTE) (Supplementary data online, Movie S1) showed a single, large oval cyst (39 × 56 × 38 mm). The edge was well defined (Panel A), it was intramyocardial and fluid-filled. It was located in the infero-postero-apical segment, protruding into the pericardium but mainly bulging into the left ventricular cavity (Supplementary data online, Movie S2). L3DTTE (Supplementary data online, Movie S3) allowed cropping of this cystic mass in transverse, sagittal (Panel B), and oblique planes, showing an apico-infero-posterior intramyocardial ellipsoid cystic mass with liquid content and well-defined edges. These data showed a life-threatening mass, mainly due to the possibility of intrapericardial and/or left ventricular rupture as well as systemic embolization. Chest computed tomography (CT) (Panel C) confirmed the presence of a left ventricular intramyocardial cyst and also a multivesicular hepatic cyst. The patient was referred to cardiac surgery. Surgical findings (Panel D) confirmed the accuracy of the preoperative echocardiography. The postoperative course was uneventful and the patient was discharged in stable condition. Three months later, his hepatic cyst was removed with no complications. Two-dimensional TTE remain the widely used imaging modality in cardiac echinococcosis, L3DTTE was shown to complement 2DTTE by displaying the 3D volume of the cyst and spatial relation to the neighbouring cardiac structures. This information is vital, especially since surgical removal of the cyst is the treatment of choice for this uncommon, but life-threatening disease.

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