Cardiac imaging in the evaluation of mitral annulus caseous calcification

Bella, Gianluca Di; Carerj, Scipione; Andò, Giuseppe; Minutoli, Fabio; Celona, A.; Coglitore, Sebastiano; Arrigo, F

doi:10.1016/j.ijcard.2006.07.084

Cited by 17 publications

(14 citation statements)

References 6 publications

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“…A central region of amorphous eosinophilic acellular material surrounded by macrophages and lymphocytes characterizes the microscopic examination of the expressed caseous material. The periphery shows multiple calcifications and zones of necrosis (Figure ) …”

Section: Pathology and Pathophysiologymentioning

confidence: 99%

Caseous Calcification of the Mitral Annulus: A Review

Elgendy

Conti

2013

Clinical Cardiology

132

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Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC). Since most cardiologists are unfamiliar with CCMA, it is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. In most cases, conservative management for this lesion is sufficient. In this review, we will discuss the various aspects of this condition and illustrate the gross and histologic pathology as well as various imaging modalities (Ultrasound, Computed tomography, Cardiac Magnetic resonance) to assess this unusual cardiac mass.

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Section: Pathology and Pathophysiologymentioning

confidence: 99%

Caseous Calcification of the Mitral Annulus: A Review

Elgendy

Conti

2013

Clinical Cardiology

132

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“…Caseous mitral annular calcification is a rare and relatively unknown form of mitral annular calcification with an unidentified pathomechanism [8]. Echocardiographically it is described as a round mass with a central echolucent area consisting of a putty-like admixture of fatty acids, cholesterol and calcium [9,10]. It can easily be mistaken for a tumor or abscess, which may sometimes lead to unnecessary surgery.…”

Section: Discussionmentioning

confidence: 99%

Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient – multimodality imaging approach to incidental echocardiographic finding

et al. 2014

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SummaryBackgroundCaseous calcification of mitral annulus is rather rare echocardiographic finding with prevalence of 0.6% in pts. with proven mitral annular calcification and 0.06% to 0.07% in large series of subjects in all ages. Echocardiographic images of caseous calcification are often heterogenous due to calcium and lipid deposits, and the masses show hyperechogenic and hypoechogenic areas. However the appearance of caseous calcification can imitate that of abscess, tumors and cysts, surgical treatment may not be needed when there is no obstruction.Case Report76-year old obese (BMI 32 kg/m2), female patient with history of hypertension, stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with no symptoms of mitral valve dysfunction and had no abnormalities on physical exam. Transesophageal echocardiography identified well-organized, composite, immobile lesion (22×15 mm) localized in the posterior part of the mitral annulus, with markedly calcified margins, and no significant impact on the valve function. In computed tomography (CT) lesion was described as calcified (24×22×17.5 mm), connected with posterior leaflet and posterior part of the mitral annulus, reducing posterior leaflet mobility. CT brought the suggestion of caseous mitral annular calcification. Coming to a conclusion, bearing in mind no mitral valve dysfunction at that time, patient was offered conservative treatment.ConclusionsAlthough caseous mitral annular calcification is typically an incidental finding, accurate recognition is needed to avoid mistaking the lesion for a tumor or abscess, which may result in unnecessary cardiac surgery. However this entity is diagnosed on cardiac MRI, multi-modality imaging, especially non-contrast CT, allows for the confident, prospective diagnosis.

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“…Histologically, CCMA is characterised by a central region of pasty material with a dense, amorphous and basophilic substance, sparse histiocytes with areas of central liquefaction and scattered calcifications predominantly located in the peripheral regions of the lesion [2]. There is a reported prevalence of 0.068% [3].…”

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confidence: 99%