Cardiac Calcified Amorphous Tumor Research Articles

Clinical Features of Cardiac Calcified Amorphous Tumor: A Narrative Review.

A cardiac calcified amorphous tumor (CAT) is a non-neoplastic cardiac mass composed of calcified nodules surrounded by amorphous fibrous tissue in a context of degeneration and chronic inflammation. Although CAT cases are increasingly reported, its clinical manifestation remains unclear. We aimed to conduct a narrative review of CAT and identify its clinical characteristics. We conducted a comprehensive literature search using PubMed, with the keyword "Cardiac Calcified Amorphous Tumor" to identify relevant articles. A total of 113 articles published between 1997 and 2022 were retrieved. The clinical features allowing for assess patient background, differences with and without end-stage renal disease (ESRD), symptom-related factors, risk factors for embolism caused by CAT, and features of CAT, such as shape, location, mobility, pathology, and treatment, were statistically analyzed in 106 criteria-matched cases. The mean patient age was 60.2 ± 18.6 years, with 45 men and 61 women. Of the data collected from 21 countries, 52 patients were from Japan. Mobile CAT was more common in the chronic renal failure group. Linear, club-shaped, and spindle-shaped CAT tended to be mobile and more common in the ESRD group as well as located in the mitral valve region. The shape, mobility, location, and underlying mechanism of CAT depended on the presence or absence of ESRD. The risk of embolism was considered high because mobile CAT was more common in the ESRD group, and CAT originated in the mitral valve region. Hence, early diagnosis based on periodic examination in patients with ESRD and aggressive surgical treatment are necessary.

Kiosk 3Q-TA-01 - A Case of a Cardiac Calcified Amorphous Tumor Mimicking a Left Atrial Myxoma

Kiosk 3Q-TA-01 - A Case of a Cardiac Calcified Amorphous Tumor Mimicking a Left Atrial Myxoma

A rare case of cardiac calcified amorphous tumor in a 34-year-old woman diagnosed at autopsy

Abstract Introduction/Objective Cardiac calcified amorphous tumor (CAT) is an uncommon, non-neoplastic heart lesion with an unknown incidence due to its rarity. Some authors have reported a female predominance of 62.5%. Many cases are associated with end-stage renal disease, diabetes mellitus and coronary artery disease. Dysfunction of calcium- phosphorus metabolism and hypercoagulability are thought to contribute to its pathogenesis. This is the first case reported from our institution. Methods/Case Report We present the case of a 34-year-old woman with a remote history of ulcerative colitis, type 1 diabetes mellitus, hypertension, Hashimoto thyroiditis, cardiomegaly, and end-stage renal disease on continuous hemodialysis. She had multiple hospitalizations for mesenteric ischemia and small bowel resections. She was admitted multiple times in 2021 for complaints of pain in bilateral thighs, shortness of breath, frequent loose stools, and abdominal pain. She was poorly compliant with hemodialysis. A chest x-ray showed severe enlargement of the cardiac silhouette. A CT angiogram of the abdomen and pelvis showed arteriosclerosis of the superior mesenteric, inferior mesenteric and celiac arteries. The patient presented to the hospital in February 2022 with continuous abdominal pain, gluteal pain, and diarrhea. Her creatinine was consistently elevated at 3.52 mg/dL. On the sixth day of admission, she was found unresponsive and was pronounced dead. Autopsy showed cardiomegaly (600 grams) with left ventricular hypertrophy, recent myocardial infarction of the posterolateral left ventricle and moderate to severe coronary artery atherosclerosis. There were lesions composed of calcified amorphous material involving the mitral valve, the endocardium and subendocardial portions of the left and right ventricles, consistent with multifocal cardiac calcified amorphous tumor. The largest lesion measured 4.0 cm. The cause of death was myocardial infarction complicating type 1 diabetes mellitus and end-stage renal disease. Results (if a Case Study enter NA) NA Conclusion CATs are usually asymptomatic but possible symptoms include dyspnea and syncope. As a result, they are often incidental findings. The calcified deposits may embolize, causing pulmonary embolism and cerebral infarction. CAT is most frequently observed in the left heart, especially on the mitral annulus; however, the right side of the heart can also be affected. End-stage renal disease is a predisposing condition, as seen in this patient.

Cardiac Calcified Amorphous Tumor: An Unusual Etiology for Recurrent Cardioembolic Strokes (P3-5.026)

<h3>Objective:</h3> To report a patient with recurrent cardioembolic strokes, in whom an underlying calcified amorphous tumor (CAT) of the heart was detected as the etiology, 2 years after initial presentation. <h3>Background:</h3> CAT of the heart is a rare intracavitary cardiac mass characterized histologically by amorphous fibrinous material and calcification. It has a tendency for embolism. We use this illustrative case to bring awareness for this rare entity and utility of advanced cardiac imaging. <h3>Design/Methods:</h3> An 87-year-old woman with recurrent recent strokes was evaluated for her 5^th stroke. Her neuroimaging had suggested an embolic etiology, but routine cardiac workup had not identified a source. After her 5^th stroke happened despite being on anticoagulation, a trans-esophageal ECHO (TEE) was done followed by cardiac MRI. <h3>Results:</h3> TEE and MRI showed a left atrial non-enhancing calcified mass attached by a stalk to the interatrial septum suspicious for CAT. The tumor was surgically resected. Histological examination showed nodular amorphous calcification against the background of degenerating fibrinous material consistent with CAT. The immediate post-operative period was uneventful, and the patient was discharged to a rehabilitation facility on aspirin monotherapy. <h3>Conclusions:</h3> CAT is a rare cardiac tumor, and its presence is suggested by the presence of calcification of an intracardiac mass on cardiac imaging. The presence of mitral annular calcification (MAC) and renal disease can be additional clues to CAT being the cause for an intracardiac mass, which can then be identified by advanced cardiac imaging. A definitive diagnosis can be made only on pathology, and the definitive treatment is surgical. MAC-related CAT can grow rapidly, has a high embolic risk, and should be removed expeditiously to prevent embolic strokes, even in asymptomatic individuals. <b>Disclosure:</b> Mr. Sharma has nothing to disclose. Dr. Annam has nothing to disclose. Bilal Ali has nothing to disclose. Dr. Guler has nothing to disclose. Dr. Hussein has nothing to disclose.

Multiple cardiac calcified amorphous tumors with morphologically different characteristics complicated by aortic regurgitation: a case report

BackgroundCardiac calcified amorphous tumors (CATs) are non-neoplastic cardiac tumors of unknown origin and etiology. Several simultaneous CATs rarely occur in multiple cardiac chambers. Although CATs carry a benign prognosis, they have a risk of complications such as systemic embolism.Case presentationWe report the case of a 79-year-old woman with two CATs and aortic regurgitation due to perforations of aortic cusps. She underwent surgical tumor resection with aortic valve replacement. The CATs were macroscopically and histologically different, which may suggest different developmental stages. One CAT was in the left atrium; it was less mobile and had nodular calcifications within dense fibrous tissue. The other CAT was in the left ventricular outflow tract; it was highly mobile, with nodular calcifications surrounded by amorphous fibrin and sanguineous deposits. The highly mobile CAT mechanically damaged the aortic cusps and caused perforations. The patient has survived over 2 years with no recurrence of the cardiac masses on echocardiography.ConclusionThe patient underwent surgical resection for two CATs. The tumors occurred in different areas and had different macroscopic and histological characteristics. We recommend early resection for highly mobile CATs because of the high risks of embolization and injuries to the surrounding tissues.

Cardiac Calcified Amorphous Tumor Presenting with Thromboembolism in a Patient Under Apixaban Treatment

Cardiac Calcified Amorphous Tumor Presenting with Thromboembolism in a Patient Under Apixaban Treatment

Cardiac calcified amorphous tumor with sustained ventricular tachycardia

Cardiac calcified amorphous tumors are rare non-neoplastic intracavitary masses with unknown cause. A 60-year-old man presented with sustained ventricular tachycardia. Transthoracic echocardiography and contrast-enhanced angio-computed tomography demonstrated an expanding 73 × 40 mm sized calcified mass in the left ventricle. He underwent successful total removal of the mass and cryo-ablation at the normal myocardial border. Histopathological examination confirmed a diagnosis of cardiac calcified amorphous tumors. The postoperative course was uneventful, without ventricular tachycardia recurrence. To our knowledge, this is the first reported case of confirmed cardiac calcified amorphous tumors causing ventricular tachycardia and treated by surgical resection combined with cryo-ablation.

Cardiac Calcified Amorphous Tumor is Vanishing

Cardiac Calcified Amorphous Tumor is Vanishing

Calcified amorphous tumor with caseous calcification of mitral annulus in hemodialysis patients.

Mitral annular calcification (MAC) is a common finding, especially among the elderly. Caseous calcification of the mitral annulus (CCMA) is a rare variant of MAC. Calcified amorphous tumor (CAT) is an extremely rare non-neoplastic cardiac tumor accompanied by calcification and is often associated with MAC. We encountered two patients with end-stage renal failure in whom a cardiac CAT developed on the mitral annulus. In both patients, preoperative examination showed MAC of the posterior mitral annulus and a mobile mass attached to the MAC. CAT and CCMA were considered, and surgical resection was performed because of a high risk of systemic embolization. Intraoperatively, the mobile mass was associated with the CCMA. The CCMA with the mass was entirely removed, and the diagnosis of CAT was histologically confirmed. We herein report these two cases of CAT arising from CCMA in patients undergoing hemodialysis and propose the characteristic imaging features and operative findings.

Multimodal imaging of cardiac-calcified amorphous tumor

Cardiac-calcified amorphous tumor (CAT) is a rare non-neoplastic tumor and its origin and pathogenesis are still unclear. In addition, it is difficult to clinically diagnose as cardiac CAT without pathological findings. We present a case of a 78-year-male diagnosed with cardiac CAT after surgical resection. We could evaluate tumor aspects by multimodal imaging including echocardiography, contrast-enhanced computed tomography (CT), magnetic resonance image, and 18F-fluorodeoxyglucose-positron emission tomography/CT before surgery.

Cardiac Calcified Amorphous Tumor Presenting as Cerebral Infarction

Cardiac Calcified Amorphous Tumor Presenting as Cerebral Infarction

Cardiac Calcified Amorphous Tumor as a Rare Cause of Ischemic Stroke

Cardiac Calcified Amorphous Tumor as a Rare Cause of Ischemic Stroke

An Autopsy Case of Cardiac Calcified Amorphous Tumor Followed up for 10 Years

An Autopsy Case of Cardiac Calcified Amorphous Tumor Followed up for 10 Years

A Cardiac Calcified Amorphous Tumor Associated with End-stage Renal Disease: An Emerging Disease Concept

A Cardiac Calcified Amorphous Tumor Associated with End-stage Renal Disease: An Emerging Disease Concept

Cardiac calcified amorphous tumors: CT and MRI findings.

We aimed to evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cardiac calcified amorphous tumors (CATs). CT and MRI findings of cardiac CATs in 12 patients were included. We retrospectively examined patient demographics, location, size, shape configuration, imaging features, calcification distribution of tumors, and accompanying medical problems. There was a female predominance (75%), with a mean age at presentation of 65 years. Patients were mostly asymptomatic on presentation (58.3%). The left ventricle of the heart was mostly involved (91%). CT findings of CATs were classified as partial calcification with a hypodense mass in four patients or a diffuse calcified form in eight. Calcification was predominant with large foci appearance as in partially calcified masses. On T1- and T2-weighted magnetic resonance images, CATs appeared hypointense and showed no contrast enhancement. The shape and configuration of cardiac CATs are variable with a narrow spectrum of CT and MRI findings, but large foci in a partially calcified mass or diffuse calcification of a mass on CT is very important in the diagnosis of cardiac CATs. Masses show a low signal intensity on T1- and T2-weighted images with no contrast enhancement on MRI.

Surgical removal of calcified amorphous tumor localized to mitral valve leaflet without mitral annular calcification.

A cardiac calcified amorphous tumor (CAT) localized to the mitral valve leaflet without mitral annular calcification (MAC) is a rare entity. We report a case of a 69-year-old woman with such a condition, who underwent successful excision of the tumor and mitral valvuloplasty using a glutaraldehyde-treated autologous pericardium. During 38 months of follow-up, no recurrence of a cardiac mass has been recognized. This report addresses questions on the surgical indication for CAT, particularly in cases without MAC, and reviews CATs of the mitral valve.

A left atrial calcified amorphous tumor

In this article, we present a 82-year-old female case without any previous history of heart disease diagnosed with a hyperdense mass originating in left atrial side of the interatrial septum on echocardiography. The patient was scheduled for surgery. Left atrium was entered through the interatrial groove. The tumor was found attached to the interatrial septum. It was macroscopically creamish-yellow colored, 20x10 mm in size and solid in texture. It was totally resected from its attachments to the interatrial septum. Light microscopy showed polypoid formations with prominent papillary structures including scattered hyalinized areas and large areas of calcification. The mass was pathologically diagnosed as cardiac calcified amorphous tumor. She was discharged under medical treatment on seventh day after surgery.

Cardiac calcified amorphous tumour.

Calcified amorphous tumour (CAT) is an unusual non-neoplastic cardiac mass that may mimic malignant tumour of the heart (1) or vegetation (2). We report a 43-year-old female with type 1 diabetes and end-stage diabetic kidney disease on haemodialysis, who underwent transoesophageal echocardiography (TOE) in the setting of pyrexia and negative blood cultures. No valve-related vegetation was identified. However, a prominent calcified immobile finger-like mass, measuring 23 mm×10 mm, was detected arising from the posterior mitral annulus adjacent to the base of P3 scallop (Fig. 1). The mass did not cause any obstruction to mitral forward flow (mean transmitral gradient 4 mmHg). Imaging of the mitral valve in the mid-oesophageal 0° view at the A2/P2 level revealed the mass to be ‘dangling’ on the upstream side of the mitral valve leaflets (Fig. 2). A subsequent 3D TOE image clearly demonstrated that the mass projects in an oblique position from the posterior mitral annulus (adjacent to base of P3) towards the mitral orifice space anterior-superior to the P2 scallop (Fig. 3 and Video 1) giving rise to the appearance as shown in Fig. 2. The patient has been entered into an annual echocardiographic surveillance programme to monitor progression of the mass. The association between CAT and end-stage kidney disease is thought to relate to dysfunctional calcium homeostasis mechanisms (3). Figure 1 2D transoesophageal echocardiography (mid-oesophageal 90° view) image of CAT arising from the posterior mitral annulus. Figure 2 2D transoesophageal echocardiography (mid-oesophageal 0° view; A2/P2 level) image of CAT ‘dangling’ on the upstream/atrial side of the mitral valve. Figure 3 3D transoesophageal echocardiography image of CAT projecting in an oblique position towards the centre of the mitral valve orifice. Video 1 3D transoesophageal echocardiography video of CAT viewed from the left atrium. Download Video 1 via http://dx.doi.org/10.1530/ERP-14-0072-v1. Download Video 1

Cardiac calcified amorphous tumor: A systematic review of the literature

BackgroundCalcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracavitary cardiac mass. Several case reports have been published but large series are lacking. ObjectiveTo determine clinical features, current management and outcomes of this rare disease. DesignA systematic review of all articles reporting cases of CAT in order to perform a pooled analysis of its clinical features, management and outcomes. Data sourcesAn electronic search of all English articles using PUBMED was performed. Further studies were identified by cross-referencing from relevant papers. Inclusion criteriaWe restricted inclusion to articles reporting cases of CAT in the English language literature published up to July 2014. Data extractionOne author performed data extraction using predefined data fields. ResultsA total of 27 articles, reporting 42 cases of CAT were found and included in this review. ConclusionIn this review, the most frequent presenting symptoms were dyspnea and embolic events. Mitral valve and annulus were the most frequent location of CAT. Surgery was most of the time required to confirm diagnosis, and was relatively safe. Overall outcome after surgical resection was good.

Calcified amorphous tumor in left atrium presenting with cerebral infarction.

Calcified amorphous tumor (CAT) of the heart is an extremely rare cardiac mass. We describe a case of cardiac CAT in a 70-year-old Korean female who presented with acute onset dysarthria and right side weakness. Echocardiography and chest computed tomography revealed a left atrial mass that originated from the interatrial septum. The patient underwent surgical resection and pathologic examination demonstrated CAT. Postoperative course was uneventful and she was followed without recurrence.