Multimodality imaging in the diagnosis of caseous calcification of mitral annulus
Archives of Cardiovascular Diseases, cilt.107, sa.2, ss.140-141, 2014 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 107 Sayı: 2
- Basım Tarihi: 2014
- Doi Numarası: 10.1016/j.acvd.2012.04.006
- Dergi Adı: Archives of Cardiovascular Diseases
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.140-141
- Anahtar Kelimeler: Caseous calcification, Three-dimensional echocardiography, Cardiac computed tomography, Magnetic resonance imaging
- Sağlık Bilimleri Üniversitesi Adresli: Hayır
Özet
78-year-old woman was admitted to our outpatient clinic with shortness of breath. Hermedical history revealed hypertension, diabetes mellitus and hyperlipidaemia. Physicalexamination was unremarkable except for apical 2/6 systolic murmur. Two-dimensionaltransthoracic echocardiographic (2D TTE) apical four-chamber and two-chamber viewsshowed a hyperechogenic mass around the region of the posterior mitral annulus andmild mitral regurgitation (Fig. 1A and B, arrow; Video 1A). Full-volume three-dimensionaltransthoracic echocardiography (3D TTE) after cropping the left and right ventricle wallsrevealed a mass arising from the posterior mitral valve annulus (Fig. 1C). Full-volume 3DTTE after cropping the left and right atrium walls showed a mass extending into the leftatrium (Fig. 1D). To clarify this pathology, we performed cardiac computed tomography(CT) and magnetic resonance imaging (MRI). A non-contrast axial CT image demonstrateda hyperdense mass at the base of the posterior mitral valve (Fig. 1E). Axial steady-statefree-precession MRI showed a hypointense mass (Fig. 1F). T1 black-blood (Fig. 1G), T2black-blood (Fig. 1H) and late gadolinium enhancement (LGE) MRI images (Fig. 1I) formass characterization confirmed the diagnosis of caseous calcification. LGE is partic-ularly interesting in the diagnosis as it shows very unique peripheral enhancement ofthe mass. Caseous calcification of mitral annulus (CCMA) is a rare form of mitral annu-lar calcification that is most commonly seen in the posterior mitral annulus. CCMA is abenign lesion, so it is important to make a differential diagnosis from a tumour, thrombus, cyst or abscess, which would require very different manage-ment. For this reason, we should perform the full spectrumof non-invasive cardiac imaging modalities in the diagnosisof CCMA. © 2012 Elsevier Masson SAS. All rights reserved.