Caseous mitral annular calcifications: Multimodality imaging characteristics

Abstract

Author contributions: Shriki J served as the primary author and wrote and finalized the manuscript; Rongey C and Ghosh B researched and wrote the clinical histories of the patients presented; Daneshvar S obtained echocardiographic images and contributed to the sections of the manuscript discussing the echocardiographic appearance of caseous mitral annular calcifications; Colletti PM contributed to the discussion regarding the cardiac MR findings in the patients who were discussed; Farvid A assisted in the discussion of the clinical significance of mitral annular calcifications, and obtained IRB approval for this review; Wilcox A assisted in editing and finalizing the manuscript. AbstractThe authors report herein a series of 3 patients with caseous mitral annular calcifications (MAC). One of the patients presented with mass-like, caseous MAC as an incidental finding on a staging computed tomography (CT) for metastatic colorectal carcinoma. Another patient presented with a nodule on a chest radiograph, which was later found on CT to be due to caseous MAC. In the third patient, caseous MAC was initially detected on echocardiography, and was further evaluated with CT and cardiac magnetic resonance imaging. In all three patients, the appearances posed a diagnostic dilemma. The appearance of caseous MAC is dissimilar to non-caseous MAC and is usually seen as an ovoid, mass-like structure, with homogeneous hyperattenuation, representing a liquefied form of calcium and proteinaceous fluid. This homogeneous center is surrounded by peripheral, shell-like calcifications. Caseous MAC is likely an under-recognized entity and may present a diagnostic dilemma at CT, magnetic resonance imaging, or echocardiography.

Caseous mitral annular calcification mimicking a lung tumor on chest X-ray

“…[ 7 ] MAC has also been controversially associated with conduction abnormalities, atrial fibrillation, coronary artery disease, stroke risk. [ 8 ]…”

“…Caseous calcification of the mitral annulus is a rare variant of MAC constituting about 0.63% of all MAC cases[ 9 ] but was present in 2.7% of individuals in a large autopsy series. [ 8 ] Caseous MAC is more likely to be mistaken for a cardiac mass or abscess. [ 8 ] Unlike other cardiac masses, MAC demonstrates hyperattenuation on unenhanced CT.[ 8 ] Non-caseous MAC usually forms a C shape around the mitral valve and are more hyperattenuating.…”

Mitral Annular Caseous Calcification: A Rare Variant of a Common Echocardiographic Finding Discovered with Advanced Imaging Techniques

“…In this entity, the internal aspect of the MAC deposit becomes a liquefied mixture of calcium, cholesterol, fatty acids and forms a soft mass with a central liquid core of toothpaste-like consistency [1]. The echocardiographic prevalence is 0.6% in patients with MAC and 0.06% to 0.07% in large series of patients in all ages [2].…”

Казеозный Кальциноз Митрального Клапана

“…ККМК нередко ассоциирован с такими состояниями, как артериальная гипертония, ишемическая болезнь сердца, фибрилляция предсердий, болезни почек, сахарный диа бет [1,2]. Также ККМК был описан у больных с синдро мом Марфана и болезнью Барлоу [4].…”