Two cases of massive mitral annular calcification mimicking left atrial neoplasms

Abstract

The authors describe two cases of massive mitral annular calcification, initially picked up on echocardiography and suspected of being neoplastic. Subsequent evaluation by CT scanning confirmed the location, aetiology, structure and diagnosis. Both cases demonstrated large masses, with calcification of varying density. This is likely explained by the presence of the previously reported amorphous caseous material demonstrated to be present within such mass structures. Such a feature is described as caseous degeneration. Both patients described have been managed conservatively with medical therapy, predominantly due to their age and general frailty.

Figure 1

Echocardiogram in left parasternal view (a) shows a mass in the posterior mitral region. A precontrast axial CT short image (b) shows a large highly calcified mass with the long-axis (c) contrast image showing its precise location (arrows) and variable density (high as large arrow and low as black star).

Figure 2

Chest x-ray (a) shows dense calcification in the mitral area (arrows) which on a magnified echocardiographic four chamber view (b) is demonstrated to be an ellipsoid mass (arrows). A contrast short-axis CT scan (c) shows the location of the large calcified mass (arrows) in the region of posterior mitral annulus, outlined on the inside by the posterior mitral leaflet (small arrows) and containing high and low density regions.