Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Apr 28:79:88-90.
doi: 10.12659/PJR.889830. eCollection 2014.

Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient - multimodality imaging approach to incidental echocardiographic finding

Olga Możeńska  1 , Sławomir Sypuła  1 , Małgorzata Celińska-Spoder  1 , Jerzy Walecki  2 , Dariusz A Kosior  3
Affiliations
Case Reports

Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient - multimodality imaging approach to incidental echocardiographic finding

Olga Możeńska et al. Pol J Radiol. .

Abstract

Background: Caseous calcification of mitral annulus is rather rare echocardiographic finding with prevalence of 0.6% in pts. with proven mitral annular calcification and 0.06% to 0.07% in large series of subjects in all ages. Echocardiographic images of caseous calcification are often heterogenous due to calcium and lipid deposits, and the masses show hyperechogenic and hypoechogenic areas. However the appearance of caseous calcification can imitate that of abscess, tumors and cysts, surgical treatment may not be needed when there is no obstruction.

Case report: 76-year old obese (BMI 32 kg/m(2)), female patient with history of hypertension, stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with no symptoms of mitral valve dysfunction and had no abnormalities on physical exam. Transesophageal echocardiography identified well-organized, composite, immobile lesion (22×15 mm) localized in the posterior part of the mitral annulus, with markedly calcified margins, and no significant impact on the valve function. In computed tomography (CT) lesion was described as calcified (24×22×17.5 mm), connected with posterior leaflet and posterior part of the mitral annulus, reducing posterior leaflet mobility. CT brought the suggestion of caseous mitral annular calcification. Coming to a conclusion, bearing in mind no mitral valve dysfunction at that time, patient was offered conservative treatment.

Conclusions: Although caseous mitral annular calcification is typically an incidental finding, accurate recognition is needed to avoid mistaking the lesion for a tumor or abscess, which may result in unnecessary cardiac surgery. However this entity is diagnosed on cardiac MRI, multi-modality imaging, especially non-contrast CT, allows for the confident, prospective diagnosis.

Keywords: Mitral Annulus Calcification; Mitral Valve; Multimodality Imaging.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Caseous mitral annular calcification: (A) Transesophageal echocardiography, (B) computed tomography, (C, D) computed tomography – 3D reconstruction.
Figure 2
Figure 2
Caseous mitral annular calcification: Computed tomography.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Stone E, Cohn D, Deal C, Pollock C. Calcific atrial mass in end-stage renal failure. Nephrol Dial Transplant. 1997;12(4):807–10. - PubMed
    1. Harpaz D, Auerbach I, Vered Z, et al. Caseous calcification of the mitral annulus: a neglected, unrecognized diagnosis. J Am Soc Echocardiogr. 2001;14(8):825–31. - PubMed
    1. Kronzon I, Winer HE, Cohen ML. Sterile, caseous mitral anular abscess. J Am Coll Cardiol. 1983;2(1):186–90. - PubMed
    1. Chahal M, Temesy-Armos P, Stewart WJ. Big MAC: caseous calcification of the mitral annulus referred for possible cardiac tumor. Echocardiography. 2011;28(4):E76–78. - PubMed
    1. Teja K, Gibson RS, Nolan SP. Atrial extension of mitral annular calcification mimicking intracardiac tumor. Clin Cardiol. 1987;10(9):546–48. - PubMed

Publication types

LinkOut - more resources