Caseous calcification of the mitral annulus on MDCT: a rare intracardiac mass

Abstract

Caseous calcification of the mitral annulus is a rare form of chronic degenerative process in the mitral valve fibrous ring with a mass-like appearance that has to be in the differential of the radiologist and cardiologist. We present the case of an 82-year-old woman in whom a tumor-like calcified mass in the posterior side of the mitral valve annulus was detected at echocardiography, and the diagnosis of caseous calcification was confirmed on multidetector computed tomography (MDCT). The diagnostic features of this rare cardiac mass are described.

Keywords: Caseous calcification; cardiac; echocardiography; mitral annulus; multidetector computed tomography (MDCT).

Fig. 1.

Transthoracic echocardiographic: apical four-chamber view (a), parasternal long axis (b), and short axis (c) views: showing an echodense, spherical, tumor-like mass located in the region of posterior mitral annulus (arrowheads), with a heterogeneous central area (arrow). Note that acoustic shadowing artifacts behind the calcification are absent. Ao, aorta; LA, left atrium; LV, left ventricle; MV, mitral valve.

Fig. 2.

MDCT in axial (a, b) and four-chamber (c, d) views after injection of contrast: a hyperdense mass with hypodense unenhanced center and a calcified peripheral rim located at the anterior and posterior side of the mitral valve annulus. The four-chamber view shows the crescent-shaped dense mass.

Fig. 3.

MDCT, long axis (a), short axis (b), and two-chamber (c) views: a tumor-like mass with a hypodense central area and peripheral dense calcification in the mitral valve annulus. Short-axis view (b) shows heterogeneity of the caseous calcification; this is confirmed by widely varying densities, including low attenuation value indicating fatty degeneration, as well as very high values indicating dense calcifications. Two-chamber view of the mass (c) demonstrates the close relation to the mitral valve.

Fig. 4.

Volume-rendered CT image (a) shows the caseous calcification in the periannular region of the mitral valve (arrow). Coronal view of the caseous calcification, with maximum intensity projection reconstruction (MIP) (b).