Cerebral Embolism Associated with Calcified Amorphous Tumor: A Review of Cerebral Infarction Cases

Nishiguchi, Yamato; Matsuyama, Hirofumi; Shindo, Akihiro; Matsuura, Keita; Niwa, Atsushi; Hirota, Y; Fukuma, Tomoyuki; Ito, Hisato; Kikuchi, Yuji; Tomimoto, Hidekazu

doi:10.2169/internalmedicine.6262-20

Cited by 6 publications

(7 citation statements)

References 19 publications

(20 reference statements)

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“…Embolic events typically involve the brain or retina 10. Rare clinical presentations include multiple cardiac masses,11 presentation in the neonatal period,12 and infected CAT 13…”

Section: Discussionmentioning

confidence: 99%

Cardiac calcified amorphous tumour: an unusual aetiology for recurrent cardioembolic strokes

Sharma,

Annam,

Guler

et al. 2024

BMJ Case Rep

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We report an elderly woman with vascular risk factors and recurrent cardioembolic strokes in whom the stroke aetiology was finally ascertained to be a calcified amorphous tumour of the heart after repeated negative investigations for embolic aetiology over 2 years. This report discusses the clinical and imaging characteristics of calcified amorphous tumours of the heart with emphasis of recent advances in cardiac imaging.

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“…Embolic events typically involve the brain or retina 10. Rare clinical presentations include multiple cardiac masses,11 presentation in the neonatal period,12 and infected CAT 13…”

Section: Discussionmentioning

confidence: 99%

Cardiac calcified amorphous tumour: an unusual aetiology for recurrent cardioembolic strokes

Sharma,

Annam,

Guler

et al. 2024

BMJ Case Rep

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“…CAT is an extremely rare non-neoplastic intracardiac tumor composed of calcified nodules and amorphous materials and is most commonly found in the mitral valve [1]. A recent study reported that CAT is usually associated with heart valve disease, hemodialysis, MAC, and diabetes mellitus [4].…”

Section: Discussionmentioning

confidence: 99%

“…A calcified amorphous tumor (CAT) is a rare non-neoplastic tumor that commonly requires surgical intervention owing to embolic events [1]. Moreover, caseous mitral annular calcification (MAC) is a rare pathology that causes serious embolic events and is sometimes associated with CAT [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Surgery for mitral annular caseous calcification-related calcified amorphous tumor: a case report

Morisaki

Sakon

Sumii

et al. 2023

Gen Thorac Cardiovasc Surg Cases

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Background A calcified amorphous tumor (a non-neoplastic tumor) with caseous calcification of the mitral annulus is a rare pathology that causes severe embolic events. We present a rare case of mitral valve surgery for a mitral annular caseous calcification-related calcified amorphous tumor found in cerebral infarction. Case presentation A 69-year-old man was diagnosed with a mitral valve calcified amorphous tumor with mitral annular caseous calcification found in cerebral infarction. He was admitted because of acute multiple embolic cerebral infarctions. A search for the embolic source through transesophageal echocardiography revealed a mitral valve tumor raised from the posterior mitral valve leaflet on the side of the left ventricle. Computed tomographic cardiac angiography revealed a calcified mitral valve tumor invading the posterior mitral valve annulus and left ventricular muscle. Intraoperative findings revealed a mitral annular calcification-related calcified amorphous tumor with caseous calcification of the posterior leaflet and annulus, which was suspected. Therefore, we performed radical debridement of the mitral annular calcification and bioprosthetic mitral valve replacement with patch repair of the posterior mitral valve annulus 2 weeks after the onset of cerebral infarction. The patient recovered well post operation, without any embolic events. Conclusions A calcified amorphous tumor with caseous mitral annulus calcification may be highly associated with embolic events. In this case, mitral valve replacement with annular patch repair may be a favorable procedure for preventing embolic events.

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“…It is not life-threatening itself, yet it is found to cause embolization. A previous study has reported pulmonary or systemic embolization in 31% of their CAT cases [ 2 ], and another study has reported approximately 20 cases of cerebral infarctions from CAT [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Multiple cerebral infarctions due to calcified amorphous tumor growing rapidly from an antecedent infection and decreasing rapidly by detachment of fibrin and antithrombotic drugs: a case report

et al. 2022

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Background Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, a calcium deposition surrounded by amorphous fibrous tissue, and possibly causes cerebral embolism. Even rarer is CAT associated with infection, and no CAT with antecedent infection has been reported to our knowledge. In addition, although some CAT in patients on hemodialysis has been reported to grow rapidly, no case has been reported on CAT that grew and diminished rapidly in a short period of time. Here, we report the case of an 82-year-old Japanese woman with normal renal function who developed multiple cerebral infarctions due to CAT that grew rapidly, associated with inflammation from an antecedent infection, and diminished rapidly by detachment of fibrin on the mass surface and antithrombotic drugs. Case presentation The patient developed fever after dental treatment and found musical hallucination on the left ear worsened in degree and frequency. In a nearby clinic, she was treated with antibiotics, and her body temperature turned to normal in approximately 1 month. She presented to our hospital for workup on the worsened musical hallucination. Magnetic resonance imaging (MRI) showed multiple cerebral infarctions, and transthoracic echocardiography (TTE) revealed an immobile hyperechoic mass with an acoustic shadow arising from a posterior cusp of the mitral valve. CAT was suspected and treated with apixaban and aspirin. Follow-up MRI and TTE showed newly developed multiple cerebral infarctions and rapidly diminished CAT. Cardiac surgery was performed to resect the CAT. The pathological findings showed calcifications surrounded by amorphous fibrous tissue including fibrin, indicating CAT. The patient’s symptoms improved and no cerebral infarctions recurred in 4 months follow-up. Conclusion Inflammation from an antecedent infection can cause CAT to grow rapidly. Fibrous tissue including fibrin may attach to the surface of CAT, resulting in multiple cerebral infarctions. Fibrous tissue may detach and disappear by antithrombotic drugs, leading to a rapid diminishment of CAT in size.

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Cerebral Embolism Associated with Calcified Amorphous Tumor: A Review of Cerebral Infarction Cases

Cited by 6 publications

References 19 publications

Cardiac calcified amorphous tumour: an unusual aetiology for recurrent cardioembolic strokes

Cardiac calcified amorphous tumour: an unusual aetiology for recurrent cardioembolic strokes

Surgery for mitral annular caseous calcification-related calcified amorphous tumor: a case report

Multiple cerebral infarctions due to calcified amorphous tumor growing rapidly from an antecedent infection and decreasing rapidly by detachment of fibrin and antithrombotic drugs: a case report

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