Two Cases of Calcified Amorphous Tumor Mimicking Mitral Valve Vegetation

Fujiwara, Masaru; Watanabe, Hiroyuki; Iino, Takako; Kobukai, Yusuke; Ishibashi, Kazuyuki; Yamamoto, Hiroshi; Iino, Kenji; Yamamoto, Fumio; Itoh, Hiroshi

doi:10.1161/circulationaha.111.072793

Cited by 38 publications

(28 citation statements)

References 3 publications

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“…They can originate in any of the 4 heart chambers and are usually associated with mitral annular calcification. 2 Because the echocardiographic features of the mass in our patient were very similar to those described in previous reports, 2 we provisionally diagnosed it as a calcified amorphous tumor before surgery.…”

supporting

confidence: 81%

Left Ventricular Lipomatous Hamartoma Mimicking a Calcified Amorphous Tumor

et al. 2016

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supporting

confidence: 81%

Left Ventricular Lipomatous Hamartoma Mimicking a Calcified Amorphous Tumor

et al. 2016

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“…7) However, it is unclear whether MAC is a direct cause of stroke or merely a marker of increased risk in association with other predictors. Masuda, et al reported a CAT localized to the mitral valve leaflet without MAC 8) ; however, most CATs originating from the mitral valve are related to extensive MAC and renal dysfunction, 3,4) as in our case. Therefore, it is likely that MAC and CAT act in concert as an embolic source.…”

Section: Discussionmentioning

confidence: 45%

“…These findings are consistent with previously reported features of cardiac CAT. [3][4][5][6]8) Although the MAC and CAT were not contiguous, the adherent CAT was very close to the heavy MACs. This particular feature suggests that the degenerative material proliferating within the calcific le-Aizawa, ET AL sion ruptured the fibrin cap and continued to develop as a CAT with embolic potential.…”

Section: Discussionmentioning

confidence: 99%

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Calcified Amorphous Tumor-Induced Acute Cerebral Infarction

et al. 2018

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SummaryWe report the case of a 38-year-old woman who was admitted for acute cerebral infarction linked to a cardiac calcified amorphous tumor (CAT) and related mitral annular calcification (MAC). The cardiac mass was removed, and mitral valve replacement surgery was performed. Pathological examination revealed an amorphous accumulation of degenerating material within both lesions, indicating that build-up of calcium along the mitral annulus and subsequent rupture of the fibrotic tissue may be involved in the initiation and progression of CAT.(Int Heart J 2018; 59: 240-242) Key words: Cardiogenic cerebral embolism, Echocardiography, Cardiac tumor C alcified amorphous tumor (CAT), first described by Reynolds, et al 1) in 1997, is a non-neoplastic cardiac tumor, and reports of some cases have suggested that CAT can cause cerebral infarction. The etiology of CAT remains unknown. CAT can arise from any of the four chambers of the heart or any of the four annuli. Most CATs originating from the mitral valve are related to extensive mitral annular calcification (MAC). 2-5)Regardless of the features of the CAT, including its site of origin, surgical excision is usually necessary. 6)Although CAT and MAC are related, there has been no reported histologic comparison of these two clinical entities. We encountered a MAC-related CAT that was responsible for a patient's cerebral infarction and also informative in terms of the tumor etiology. Case ReportA 38-year-old woman was referred to our hospital with acute right hemiplegia. She had been undergoing hemodialysis for 31 years because of chronic kidney failure resulting from systemic lupus erythematosus and secondary nephrotic syndrome and had been treated at various times with prednisolone, precipitated calcium carbonate, bixalomer, and/or cinacalcet hydrochloride. Her medical history also included rupture of a colonic diverticulum. Upon admission to our hospital, a systolic murmur was heard at the cardiac apex, and right hemiplegia with motor aphasia was observed. Brain magnetic resonance imaging showed acute cerebral infarction in the middle cerebral artery territory. Electrocardiography showed sinus tachycardia at 110 bpm.Both transthoracic echocardiography and transesophageal echocardiography revealed enlargement of the left atrium (50 × 42 mm), concentric left ventricular (LV) hypertrophy (LV mass index, 130 g/m 2 ; relative wall thickness, 0.50), mild mitral regurgitation, and a mobile cord-like structure and MAC at the middle part of the anterior leaflet ( Figure 1A, B). LV systolic function was normal with an LV ejection fraction of 67%, and LV wall motion was within normal range. No other potential source of cerebral embolism, such as a thrombus in the left atrial appendage, a patent foramen ovale, or an atrial septal aneurysm, was seen, there was no spontaneous echo contrast, and there were no physiologic or laboratory findings suggestive of infective endocarditis. No coronary artery stenosis was seen upon coronary angiography. The mobile cord-like structure was t...

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“…31% of CAT had valvular disease, 21% had end stage renal failure, 14% had diabetes, and 12% had coronary artery disease as complications. Particularly, patients with CAT developed with the mitral valve annular calcification (MAC) have reported to be closely related to the end stage renal disease with maintenance dialysis [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

A Case of Calcified Amorphous Tumor Found with Cerebral Infarction

Kimura¹,

Kato²,

Haruta³

et al. 2017

J Thrombo Cir

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A 47-year-old man with cerebral infarction and end-stage of kidney disease on hemodialysis was transferred to our hospital because of a suspicion of infective endocarditis. Although echocardiography revealed a high echoic mass on the mitral leaflet mimicking of vegetation, we finally diagnosed Calcified Amorphous Tumor (CAT) by clinical course and image findings. Because of lacking of prospective investigations despite lots of case reports, epidemiology, prognosis and appropriate treatment including surgical resection of CAT are still controversy.

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Two Cases of Calcified Amorphous Tumor Mimicking Mitral Valve Vegetation

Cited by 38 publications

References 3 publications

Left Ventricular Lipomatous Hamartoma Mimicking a Calcified Amorphous Tumor

Left Ventricular Lipomatous Hamartoma Mimicking a Calcified Amorphous Tumor

Calcified Amorphous Tumor-Induced Acute Cerebral Infarction

A Case of Calcified Amorphous Tumor Found with Cerebral Infarction

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