The First Report of Calcified Amorphous Tumor Associated with Infective Endocarditis: A Case Report and Review of Literature

Abstract

BACKGROUND Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, which is composed of calcium deposition surrounded by amorphous fibrous tissue. The clinical presentation of cardiac CAT resembles that of other cardiac tumors or vegetation, though there is no previous report of a CAT complicated with infective endocarditis. CASE REPORT A 67-year-old male with a history of end stage renal failure and gastric cancer who was on adjuvant chemotherapy presented with a cardiac mass. The mass was resected and diagnosed as CAT pathologically. Two separate sets of blood cultures were positive for Enterococcus faecalis, thus, the patient was diagnosed with infective endocarditis. Antibiotic treatment was continued for 6 weeks after surgery, and the patient recovered uneventfully. However, he died from a complication of his gastric cancer 5 months later. CONCLUSIONS This is the first report of CAT associated with infective endocarditis. Blood cultures should be obtained to differentiate infective endocarditis or CAT with infectious endocarditis from CAT alone, because CAT with infective endocarditis may present atypically and may be more likely to require antibiotic treatment along with surgery.

Figure 1.

(A, B) TTE demonstrating a mobile 29×18 mm cystic lesion with a 10×8 mm mass inside the cyst attached to the apex of the left ventricle wall.

Figure 2.

Cardiac computed tomography demonstrating a calcified apical wall lesion, a low-density mass in the apex and bilateral pleural effusions.

Figure 3.

(A, B) Surgical photographs. (A) The asterisk shows a vegetation on the aortic valve; (B) A small pit in the apex where there had been a mass legion.

Figure 4.

(A, B) Pathological examination of the excised lesion in the apex. The asterisk of (A) and (B) shows multiple nodular calcifications in both the endocardium and myocardium surrounded by amorphous fibrous tissue. (A) The arrow shows accumulation of neutrophils in the endocardium with formation of multiple small abscesses. (B) The arrow shows lymphocytic infiltration of the myocardium.