Mitral Annular Caseous Calcification: A Rare Variant of a Common Echocardiographic Finding Discovered with Advanced Imaging Techniques

Pomeroy, William L.; Markelz, Brian; Steel, Kevin; Slim, Ahmad

doi:10.1155/2013/972684

Cited by 10 publications

(9 citation statements)

References 5 publications

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“…17 The initial diagnosis of CCMA is made on echocardiography, and on occasion CT, highlighting the importance of recognising the echocardiographic features of CCMA. 18 TTE findings reveal a large, spherical, echodense mass in the periannular mitral region, with no acoustic shadowing and central areas of echolucencies resembling liquefaction. In the parasternal short-axis view, it may appear semilunar, located in the posterior region at the junction of the LA and LV.…”

Section: Discussionmentioning

confidence: 91%

“…In this patient, TOE provided more precise and detailed images of the mass, with specific echocardiographic features favouring the diagnosis of CCMA. 18,19 Multi-modality imaging with CT and cardiac MRI can lead to accurate diagnosis and improve patient outcomes and treatment options. In cases which are difficult to diagnose by echocardiography and CT alone, cardiac MRI is considered the technique of choice.…”

Section: Discussionmentioning

confidence: 99%

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Ruptured caseous calcification of the mitral annulus

Allwood

Bonacci

McKinnon

2020

Australas J Ultrason Med

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Mitral annular calcification (MAC) is considered a chronic and degenerative process involving the fibrous annulus of the mitral valve. The prevalence of MAC has been reported between 8% and 15%. It significantly increases with age, often seen in females, individuals with hypertension, chronic kidney disease and those with multiple cardiovascular risk factors. Caseous calcification of the mitral annulus (CCMA) (also known as caseoma) is a rare variant of MAC and should be considered in the differential diagnosis with other cardiac masses of the mitral valve. An 85-year-old female presented for a transthoracic echocardiogram with a history of hypertension and a systolic murmur. The echocardiogram demonstrated a possible rare variant of MAC, with independent mobile echodensities identified. Further testing using transoesophageal echocardiography was used to confirm diagnosis and ensure appropriate clinical management was arranged. This case demonstrated CCMA, a benign condition that can be mistaken for cardiac tumours, thrombus, vegetations or abscesses. A low prevalence has been reported between 0.06% and 0.07% and 0.6% of patients with MAC using echocardiography. Echocardiography can provide the initial diagnosis for identification and characterisation of MAC. CCMA appears as a calcified mass with an echolucent, liquid-like inner part, located on the posterior mitral valve annulus. Acoustic shadowing is usually absent. Multimodality imaging can lead to an accurate diagnosis of CCMA without unnecessary interventions. Transoesophageal echocardiography provides further information on the site and composition of the internal material. Computed tomography (CT) and cardiac magnetic resonance imaging (MRI) can also be used, to confirm the diagnosis and to exclude other differential diagnoses.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Ruptured caseous calcification of the mitral annulus

Allwood

Bonacci

McKinnon

2020

Australas J Ultrason Med

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“…Caseous calcification of the mitral annulus is thought to share an aetiology with mitral annular calcification, where calcium is deposited within the heart leading to a chronic degenerative process. This is commonly seen in elderly women and patients with calcium metabolism abnormalities or renal failure, suggesting that a high turnover of calcium contributes to the development of MAC 11 . The aetiology of caseous necrosis in CCMA is still debated, but similarities to atheromas seen in atherosclerotic cardiovascular disease have been suggested 8 , 11 .…”

Section: Discussionmentioning

confidence: 99%

“…This is commonly seen in elderly women and patients with calcium metabolism abnormalities or renal failure, suggesting that a high turnover of calcium contributes to the development of MAC. 11 The aetiology of caseous necrosis in CCMA is still debated, but similarities to atheromas seen in atherosclerotic cardiovascular disease have been suggested. 8 , 11 Findings such as severe calcific atherosclerosis of the coronary arteries and hypertension, both present in our case, are commonly described in patients with CCMA, further supporting this theory.…”

Section: Discussionmentioning

confidence: 99%

Caseous calcification of the mitral annulus: case report and brief review

Curl

Riemer

2018

European Heart Journal - Case Reports

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BackgroundCaseous calcification of the mitral annulus (CCMA) is a very rare variant of mitral annular calcification, which is typically asymptomatic but can manifest as a cardiac tumour, abscess, or in the form of mitral valve dysfunction.Case summaryWe present a patient who developed shortness of breath and was initially thought to have an intracardiac tumour, but ultimately was recognized as massive calcification of the mitral valve by computed tomography angiogram. This finding was unfortunately made only shortly before the patient’s clinical deterioration, and the specific diagnosis of CCMA was made on post-mortem findings, precluding any directed treatment for this entity.DiscussionCaseous calcification of the mitral annulus can lead to significant pathology, including mitral regurgitation, stenosis, or systemic embolization of caseous material. Due to its relative scarcity and tendency to be asymptomatic, a diagnosis of CCMA is often difficult to make or easily overlooked. Early recognition and appropriate treatment is crucial for avoiding these potential complications.

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“…It has been reported by Blankstein et al that the surrounding rim was 300 Hounsfield units whilst the necrotic core was 70 Hounsfield units [ 9 ]. The unique character of this mass on imaging has been discussed in the literature as an adjunct in assisting physicians in making the correct diagnosis and potentially avoiding unnecessary surgical interventions [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

A Large Cardiac Mass: Diagnosis of Caseous Mitral Annular Calcification and Determining Optimum Management Strategy

Shapera

Karimi

Castellanos³

2014

Case Reports in Medicine

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A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible stroke with a head-neck CT scan and a transthoracic echocardiogram. The head-neck CT scan was unremarkable, but the echocardiogram was notable for a 2.0 × 2.3 cm heterogeneous echodensity attached to the mitral valve. After a transesophageal echocardiogram and chest CT scan, the mass was determined to be a caseous mitral annular calcification, CMAC. This entity is a rare variant of MAC with an estimated prevalence of 0.068%. Echocardiographic techniques can distinguish CMAC from other intracardiac masses such as tumor, cyst, or abscess. CMAC is associated with cerebrovascular accidents; however, optimal treatment is controversial given the rarity of this clinical finding. Management strategies should be tailored based on the patient's presentation, risk factors, and overall clinical circumstances.

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Mitral Annular Caseous Calcification: A Rare Variant of a Common Echocardiographic Finding Discovered with Advanced Imaging Techniques

Cited by 10 publications

References 5 publications

Ruptured caseous calcification of the mitral annulus

Ruptured caseous calcification of the mitral annulus

Caseous calcification of the mitral annulus: case report and brief review

A Large Cardiac Mass: Diagnosis of Caseous Mitral Annular Calcification and Determining Optimum Management Strategy

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