Images in cardiovascular medicine. Tumor-like calcification of the mitral annulus: diagnosis with multislice computed tomography.

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HomeCirculationVol. 107, No. 2Tumor-Like Calcification of the Mitral Annulus Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBTumor-Like Calcification of the Mitral AnnulusDiagnosis With Multislice Computed Tomography G. Morgan-Hughes, BM, BS, L. Zacharkiw, CCSO, C. Roobottom, BM, BS and A.J. Marshall, MD G. Morgan-HughesG. Morgan-Hughes From the South West Cardiothoracic Centre, Plymouth NHS Trust, Derriford, Plymouth, United Kingdom. Search for more papers by this author , L. ZacharkiwL. Zacharkiw From the South West Cardiothoracic Centre, Plymouth NHS Trust, Derriford, Plymouth, United Kingdom. Search for more papers by this author , C. RoobottomC. Roobottom From the South West Cardiothoracic Centre, Plymouth NHS Trust, Derriford, Plymouth, United Kingdom. Search for more papers by this author and A.J. MarshallA.J. Marshall From the South West Cardiothoracic Centre, Plymouth NHS Trust, Derriford, Plymouth, United Kingdom. Search for more papers by this author Originally published21 Jan 2003https://doi.org/10.1161/01.CIR.0000047070.50407.D6Circulation. 2003;107:355–356An 83-year-old woman underwent transthoracic echocardiography (TTE) to assess her left ventricular systolic function. The TTE showed a large, round, echo-dense mass with central echo-lucencies resembling a posterior periannular tumor.There was no associated mitral valvular dysfunction, and left ventricular function was good. Further assessment was performed using electrocardiographic-gated cardiac multislice computed tomography. This demonstrated that the mass seen on TTE was due to gross calcification of the posterior portion of the mitral valve annulus (Figures 1 through 3). Unlike symmetrical mitral annular calcification, asymmetri- cal tumor-like calcification of the mitral annulus is a rare and often unrecognized condition. Download figureDownload PowerPointFigure 1. Multislice computed tomography of the heart. A 3-dimensional image, generated using volume rendering techniques, is seen in axial section at posterior mitral valve annulus level, showing the left atrium and an oblique cross section of the left ventricle in continuity with the aorta. The posterior mitral valve annulus is replaced by a large calcified mass.Download figureDownload PowerPointFigure 2. Calcified skeleton of the mitral valve annulus isolated by manipulation of the 3-dimensional data volume. There is marked asymmetry of the annular calcification (posterior is to the right and anterior to the left of the image).Download figureDownload PowerPointFigure 3. Virtual angioscopy from the left atrium orientated toward the mitral valve (voyager) again, demonstrating the marked asymmetry of the mitral annular calcification.Liquefaction necrosis of mitral annular calcification occurs in 3% of autopsied cases. Surgical findings in such cases reveal a pale caseous material that is culture-negative. It is not malignant, and surgery should be reserved for coexistent mitral valve lesions. The treatment in this case was conservative.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.The authors are undertaking research into the clinical applications of cardiac computed tomography. The work is supported by a grant from the Royal College of Radiologists.FootnotesCorrespondence to G.J. Morgan-Hughes, SpR Cardiology, Cardiology Department, SWCC, Plymouth NHS Trust, Derriford, Plymouth PL6 8DH, UK. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2016) Tumors and Masses ASE's Comprehensive Echocardiography, 10.1016/B978-0-323-26011-4.09955-1, (617-658), . Matsuyama T, Ishibashi-Ueda H, Ikeda Y, Nagatsuka K, Miyashita K, Amaki M, Kanzaki H and Kitakaze M (2012) Critical multi-organ emboli originating from collapsed, vulnerable caseous mitral annular calcification, Pathology International, 10.1111/j.1440-1827.2012.02826.x, 62:7, (496-499), Online publication date: 1-Jul-2012. Goldstein S (2011) Artifacts Masquerading as Intracardiac Masses Dynamic Echocardiography, 10.1016/B978-1-4377-2262-8.00062-1, (275-279), . Watanabe N, Taniguchi M, Maruo T, Murakami M, Tou N, Tanabe Y, Miyaji K, Kusano K, Koide N and Ohe T (2005) Large Calcified Mass on the Mitral Annulus, Journal of Echocardiography, 10.2303/jecho.3.123, 3:3, (123-124), . January 21, 2003Vol 107, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000047070.50407.D6PMID: 12538440 Originally publishedJanuary 21, 2003 PDF download Advertisement