The Incidence and Clinical Course of Caseous Calcification of the Mitral Annulus: A Prospective Echocardiographic Study

Deluca, Giovanni; Correale, Michele; Ieva, Riccardo; Salvatore, Bibiana Del; Gramenzi, Silvana; Biase, Matteo Di

doi:10.1016/j.echo.2007.12.004

Cited by 138 publications

(215 citation statements)

References 15 publications

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“…Echocardiographic follow-up revealed MAC to be a dynamic process with some cases transforming from a solid mass to liquefaction and regression or even complete resolution. 2 In our case, serial CMR studies support the theory of a dynamic spectrum of this disease. In our patient, the mass exhibited rapid progression with changes in consistency over 1 month starting as a homogeneous mass on the first scan, with progressive changes over 1 month to a fluid-filled cavity.…”

Section: Discussionsupporting

confidence: 59%

Serial Cardiac Magnetic Resonance Imaging of a Rapidly Progressing Liquefaction Necrosis of Mitral Annulus Calcification Associated With Embolic Stroke

et al. 2012

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M itral annulus calcification (MAC) is a common finding in the elderly. A rare manifestation of MAC is liquefaction necrosis that can be mistaken for a tumor or an abscess. Because its course is most often benign, a correct diagnosis is imperative to avoid unnecessary workup or treatment. CaseA 76-year-old woman with history of hypertension and dyslipidemia presented with chest pain and elevated cardiac enzymes. A coronary angiogram revealed no significant coronary artery disease.Echocardiogram ( Figure 1) revealed a large, solid mass within the atrioventricular groove and the lateral wall of the left ventricle. There was moderate calcification of the mitral valve annulus. Computed tomography scan of the chest (Figure 2) revealed a soft tissue density inseparable from the region of the mitral valve and the left ventricular wall. Cardiac magnetic resonance (CMR) showed a large mass involving the basal lateral wall near the atrioventricular groove, extending into the left atrium ( Figure 3A and 3B). The mass was slightly hyperintense on T1 (Figure 4) and hypointense on T2 imaging ( Figure 5). The mass was homogenous on delayed enhancement with a bright ring (Figure 6), the characteristics were not changed with fat saturation, and it was avascular by perfusion ( Figure 7). The patient was discharged from the hospital with a scheduled outpatient workup to continue.The patient returned 2 weeks later, however, with an acute stroke in Ͼ1 arterial distribution, and workup for an embolic source commenced. A CMR ( Figure 3C and 3D) revealed no left ventricular thrombus; the mass increased in size and changed in consistency, appearing semisolid.The patient underwent a left thoracotomy for a biopsy, which revealed a thick whitish fluid (Figure 8) thought to be

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Section: Discussionsupporting

confidence: 59%

Serial Cardiac Magnetic Resonance Imaging of a Rapidly Progressing Liquefaction Necrosis of Mitral Annulus Calcification Associated With Embolic Stroke

et al. 2012

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“…Caseous calcification of the mitral annulus may mimic the appearance of an intra-cardiac tumour and has been reported before, 1-9 but while the typical echocardiographic appearance is that of a mass with a central echo-lucent area, 8 our patient had a more homogenous-appearing mass. Caseous calcification is exceptionally rare, seen in around 0.005% of TTE studies.…”

Section: Discussionmentioning

confidence: 80%

Multimodality imaging of exuberant mitral annular calcification in a patient presenting with transient ischaemic attack

Vijayan

Fielding²,

Kahan³

et al. 2011

J R Coll Physicians Edinb

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An 81-year-old woman presented to the emergency department with sudden onset weakness of the right side of the body, which had caused her to fall through a glass door and injure her arm. She also had expressive dysphasia. The patient had a previous medical history of hypertension, hypercholesterolaemia and spondylosis. More than a decade ago she had been labelled as suffering from 'angina', based on asymptomatic ST-segment depression during stage 2 of a Bruce protocol. There was no history of rheumatic fever.Her weakness and expressive dysphasia resolved completely in 90 minutes. On examination, the arterial pulse was regular and normal in character, blood pressure was 138/72 mmHg in the right arm and the heart rate was 80 bpm. The patient's electrocardiogram showed sinus rhythm with occasional ventricular ectopic beats. The first heart sound was loud and there was a pansystolic murmur grade 3/6 at the mitral area. Neurological examination performed by the admitting physician was normal. Figure 1 Zoomed, slightly off-axis apical four-chamber view, demonstrating a globular mass with a hypoechoic centre, in the lateral segment of the mitral annulus. Figure 2Transoesophageal echocardiographic appearances of the mass, in a four-chamber view. The relationship with the mitral valve is better appreciated than on the transthoracic scan. The mass is located on the ventricular aspect of the annulus and distorts the posterior mitral leaflet slightly.

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“…The entity described is a rare finding termed liquifactive necrosis or caseous calcification of the mitral valve annulus (CCMA). The prevalence of CCMA is reported to be 0.6% of mitral annular calcification and 0.06-0.07% of the population referred for echocardiography [2,3]. In autopsy studies, its prevalence rises to 2.7% [1].…”

Section: Introductionmentioning

confidence: 99%

“…Calcified hydatid cysts in the heart usually shell out from the surrounding myocardium relatively easy and they show characteristic histological findings. Further differential diagnosis of lesions in this location would include lipomatosis of the atrioventricular groove and benign pericardial cysts [3].…”

Section: Case Descriptionmentioning

confidence: 99%

Caseous Calcification of the Mitral Valve Annulus Simulating an Intramyocardial Mass at Autopsy

Rizkalla¹,

O'Briain²

2016

J Cytol Histol

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Mitral annular calcification is an asymptomatic chronic degenerative process of the mitral valve, which can occur in the elderly population, associated with atherosclerosis. When it is extensive it is termed caseous calcification of the mitral valve annulus. We illustrate the pathology of this entity in the heart in an 80-year-old man, in whom it presented as a large intramyocardial cystic mass found at autopsy.

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The Incidence and Clinical Course of Caseous Calcification of the Mitral Annulus: A Prospective Echocardiographic Study

Cited by 138 publications

References 15 publications

Serial Cardiac Magnetic Resonance Imaging of a Rapidly Progressing Liquefaction Necrosis of Mitral Annulus Calcification Associated With Embolic Stroke

Serial Cardiac Magnetic Resonance Imaging of a Rapidly Progressing Liquefaction Necrosis of Mitral Annulus Calcification Associated With Embolic Stroke

Multimodality imaging of exuberant mitral annular calcification in a patient presenting with transient ischaemic attack

Caseous Calcification of the Mitral Valve Annulus Simulating an Intramyocardial Mass at Autopsy

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