Back
 IJCM  Vol.4 No.1 , January 2013
Multi Modality Imaging for Cardiac Masses Can Avoid Unnecessary Surgical Intervention: A Case Report of Caseous Calcification of Mitral Annulus
Abstract: Mitral Annular Calcification (MAC) is a degenerative process involving the fibrous ring of the mitral valve. Caseous Calcification of Mitral Annulus (CCMA) is a rare variant of MAC. This condition is benign and usually needs no treatment. This is a case report of a 67-year-old woman with non-specific symptoms in whom a cardiac tumor was suspected by transthoracic Echocardiography. The use of multi-modality imaging strategy with transesophageal Echocardiography and cardiac MR scanning revealed however the diagnosis of CCMA and spared the patient an unnecessary operation.
Cite this paper: K. Alzuhairi, T. Zaremba and E. Korup, "Multi Modality Imaging for Cardiac Masses Can Avoid Unnecessary Surgical Intervention: A Case Report of Caseous Calcification of Mitral Annulus," International Journal of Clinical Medicine, Vol. 4 No. 1, 2013, pp. 41-44. doi: 10.4236/ijcm.2013.41009.
References

[1]   D. Harpaz, I. Auerbach, Z. Vered, M. Motro, A. Tobar and S. Rosenblatt, “Caseous Calcification of the Mitral Annulus: A Neglected, Unrecognized Diagnosis,” Journal of the American Society of Echocardiography, Vol. 14, No. 8, 2001, pp. 825-831.

[2]   I. Kronzon, H. E. Winer and M. L. Cohen, “Sterile, Caseous Mitral Anular Abscess,” Journal of the American College of Cardiology, Vol. 2, No. 1, 1983, pp. 186-190. doi:10.1016/S0735-1097(83)80391-X

[3]   G. Deluca, M. Correale, R. Ieva, et al., “The Incidence and Clinical Course of Caseous Calcification of the Mitral Annulus: A Prospective Echocardiographic Study,” Journal of the American Society of Echocardiography, Vol. 21, No. 7, 2008, pp. 828-833. doi:10.1016/j.echo.2007.12.004

[4]   K. Teja, R. S. Gibson and S. P. Nolan, “Atrial Extension of Mitral Annular Calcification Mimicking Intracardiac Tumor,” Clinical Cardiology, 1987; Vol. 10, No. 9, pp. 546-548. doi:10.1002/clc.4960100918

[5]   P. Centofanti, E. Di Rosa, L. Deorsola, et al., “Primary Cardiac Neoplasms: Early and Late Results of Surgical Treatment in 91 Patients,” The Annals of Thoracic Surgery, 1999; Vol. 68, No. 4, pp. 1236-1241. doi:10.1016/S0003-4975(99)00700-6

[6]   A. W. Elbardissi, J. A. Dearani, R. C. Daly, et al., “Survival after Resection of Primary Cardiac Tumors: A 48-Year Experience,” Circulation, Vol. 118, No. 14, 2008, pp. S7-S15. doi:10.1161/CIRCULATIONAHA.107.783126

[7]   A. Burke, J. Jeudy Jr and R. Virmani, “Cardiac Tumours: An Update,” Heart, Vol. 94, No. 1, 2008, pp. 117-123. doi:10.1136/hrt.2005.078576

[8]   K. Reynen, “Cardiac Myxomas,” The New England Journal of Medicine, Vol. 333, No. 24, 1995, pp. 1610-1617. doi:10.1056/NEJM199512143332407

[9]   M. G. St John Sutton, L. A. Mercier, E. R. Giuliani, et al., “Atrial Myxomas: A Review of Clinical Experience in 40 Patients,” Mayo Clinic Proceedings, Vol. 55, No. 6, 1980, pp. 371-376.

[10]   C. A. Ridge, R. P. Killeen, K. M. Sheehan, et al., “Giant Right Atrial Myxoma: Characterization with Cardiac Magnetic Resonance Imaging,” Clinical Imaging, Vol. 34, No. 3, 2010, pp. 231-233. doi:10.1016/j.clinimag.2009.06.027

[11]   C. M. Kramer and W. G. Hundley, “Atlas of Cardiovascular Magnetic Resonance Imaging: An Imaging Companion to Braunwald’s Heart Disease,” 1st Edition, Saunders, Philadelphia, 2010.

[12]   J. F. Heitner, I. Klem, K. Alexander, et al., “The Case of the Disappearing Myxoma,” Journal of Cardiovascular Magnetic Resonance, Vol. 7, No. 5, 2005, pp. 841-843. doi:10.1080/10976640500288156

[13]   J. Vogel-Claussen, C. E. Rochitte, K. C. Wu, et al., “Delayed Enhancement MR Imaging: Utility in Myocardial Assessment,” RadioGraphics, Vol. 26, No. 3, 2006, pp. 795-810. doi:10.1148/rg.263055047

[14]   Y. L. Kwak and J. W. Shim, “Assessment of Endocarditis and Intracardiac Masses by TEE,” International Anesthesiology Clinics, Vol. 46, No. 2, 2008, pp. 105-120. doi:10.1097/AIA.0b013e31815d13ab

[15]   D. T. Durack, A. S. Lukes and D. K. Bright, “New Criteria for Diagnosis of Infective Endocarditis: Utilization of Specific Echocardiographic Findings,” American Journal of Medicine, Vol. 96, No. 3, 1994, pp. 200-209. doi:10.1016/0002-9343(94)90143-0

[16]   N. P. McKernan, W. C. Culp Jr, W. L. Knight, W. E. Johnston, R. M. Sniecinski and H. L. Lazar, “CASE 2-2012 Intraoperative Diagnosis and Management of Caseous Calcification of the Mitral Annulus,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 26, No. 2, 2012, pp. 327-332. doi:10.1053/j.jvca.2011.07.015

[17]   G. Minardi, C. Manzara, G. Pulignano, et al., “Caseous Calcification of the Mitral Annulus with Mitral Regurgitation and Impairment of Functional Capacity: A Case Report,” Journal of Medical Case Reports, Vol. 2, No. 1, 2008, p. 205. doi:10.1186/1752-1947-2-205

[18]   G. Di Bella, P. G. Masci, J. Ganame, et al., “Liquefaction Necrosis of Mitral Annulus Calcification: Detection and Characterization with Cardiac Magnetic Resonance Imaging,” Circulation, Vol. 117, No. 12, 2008, pp. e292-e294. doi:10.1161/CIRCULATIONAHA.107.729905

[19]   S. Ribeiro, A. Salgado, N. Salomé, et al., “Caseous Calcification of the Mitral Annulus: A Multi-Modality Imaging Perspective,” Revista Portuguesa de Cardiologia, Vol. 31, No. 4, 2012, pp. 313-316. doi:10.1016/j.repc.2012.02.007

[20]   S. K. Singh, A. Kumar, V. Tewarson, et al., “Calcified Left Atrial Myxoma with Osseous Metaplasia,” Indian Journal of Chest Disease and Allied Science, Vol. 54, No. 3, 2012, pp. 201-203.

[21]   S. Gramenzi, A. A. Mazzola, B. Tagliaferri, et al., “Caseous Calcification of the Mitral Annulus: Unusual Case of Spontaneous Resolution,” Echocardiography, Vol. 22, No. 6, 2005, pp. 510-513. doi:10.1111/j.1540-8175.2005.04056.x

[22]   N. Yokoyama, K. Komo, S. Suzuki, et al., “Serial Assessment of Liquefaction Necrosis of Mitral Annulus Calcification by Echocardiography and Multislice Computed Tomography,” Circulation, Vol. 115, No. 1, 2007, pp. e1-e2. doi:10.1161/CIRCULATIONAHA.106.635599

 
 
Top