Sterile, caseous mitral anular abscess

Kronzon, Itzhak; Winer, Howard E.; Cohen, Murray

doi:10.1016/s0735-1097(83)80391-x

Cited by 57 publications

(43 citation statements)

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“…2,3 Echocardiography typically identifies this entity as a round, calcified, echogenic mass. 4 CMR reveals a mass between the posterior mitral annulus and adjacent myocardium, with no enhancement after contrast administration and with strong peripheral enhancement 10 minutes after gadolinium administration with the use of the contrast-enhanced inversion-recovery technique.…”

Section: Discussionmentioning

confidence: 99%

“…1 Caseous calcification of the mitral annulus (CCMA) or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification, with a prevalence of 0.6% in this population and of 0.06---0.07% in large series of patients of all ages. 2,3 Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. …”

Section: Introductionmentioning

confidence: 99%

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Caseous calcification of the mitral annulus: A multi-modality imaging perspective

Ribeiro

Salgado

Salomé

et al. 2012

Revista Portuguesa de Cardiologia

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Mitral annulus calcification is a common echocardiographic finding, particularly in the elderly and in end-stage renal disease patients under chronic dialysis. Caseous calcification or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification. Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. The authors present the case of an 84-year-old woman with a suspicious large, echodense mass at the level of the posterior mitral leaflet with associated severe mitral regurgitation. Cardiac magnetic resonance imaging demonstrated a hypoperfused mass with strong peripheral enhancement 10 minutes after gadolinium administration. Multislice computed tomography showed the calcified nature of the mass. A multi-modality imaging approach confirmed the diagnosis of caseous calcification of the posterior mitral annulus. The patient refused surgical treatment. © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. Degenerescência caseosa da calcificação do anel mitral: uma perspectiva multi-imagem Resumo A calcificação do anel mitral é um achado ecocardiográfico comum, particularmente em idosos e doentes com insuficiência renal terminal em diálise. A degenerescêncica caseosa, ou necrose liquefeita, da calcificação do anel mitral é uma forma rara de calcificação do anel mitral. O reconhecimento precoce desta entidade evita procedimentos diagnósticos invasivos na medida em que é uma patologia benigna e, ao contrário de tumores e abcesso cardíacos, tem um bom prognóstico. Os autores apresentam o caso clínico de uma doente de 84 anos de idade com uma massa hiperecogénica ao nível do folheto posterior da válvula mitral, associada * Corresponding author. E-mail address: silviamartinsribeiro@gmail.com (S. Ribeiro). Ressonância magnética cardíaca a insuficiência mitral severa. A ressonância magnética cardíaca demonstrou uma massa hipoperfundida, com realce tardio, após administração de gadolíneo. A tomografia computadorizada cardíaca evidenciou a natureza calcificada da lesão. Uma abordagem multi-imagem permitiu o diagnóstico de calcificação caseosa do anel mitral posterior. A doente recusou cirurgia cardíaca. PALAVRAS-CHAVE

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Caseous calcification of the mitral annulus: A multi-modality imaging perspective

Ribeiro

Salgado

Salomé

et al. 2012

Revista Portuguesa de Cardiologia

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“…in a soft mass in the mitral annulus [3] . Although caseous MAC can be definitively diagnosed by its imaging features and by its classic location, it may present a diagnostic dilemma.…”

Section: World Journal Of Radiologymentioning

confidence: 99%

Caseous mitral annular calcifications: Multimodality imaging characteristics

Shriki

Rongey²,

Ghosh³

et al. 2010

WJR

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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.

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“…or light-gray pasty material with calcium, cholesterol and fatty acids. 5,8 Predisposing factors for this type of mitral annular calcification are considered to be aging, female gender, increased mitral stress such as hypertension, aortic stenosis and hypertrophic cardiomyopathy, abnormal mitral valve motion such as a mitral valve prolapse, Marfan's syndrome and mitral valve replacement, and a metabolic abnormality such as chronic renal failure, hypercholesterolemia and diabetes mellitus. [1][2][3]10,11 In the present patient the administration of calcium carbonate and a large dose of 1,25(OH)2D3 to correct the hypocalcemia and secondary hyperparathyroidism due to chronic renal failure had caused an acute change in the serum calcium level, which might have contributed to the formation of this specific form of ectopic mitral annular calcification.…”

Section: Fig 2 Computed Tomography Of An Axial View (A) and Magneticmentioning

confidence: 99%

“…1,2 Chronic renal failure is one of the predisposing factors of this condition. 1,3 We report a case of liquefaction necrosis of a mitral annular calcification mimicking an intracardiac tumor, [4][5][6][7][8] in which both gallium-67 ( 67 Ga)-citrate and technetium-99m-methylene diphosphate ( 99m Tc-MDP) uptake was noted, in a patient with chronic renal failure that had been managed by hemodialysis for 11 years. The size of the liquefaction necrosis was reduced with low calcium concentration hemodialysis.…”

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confidence: 99%

Reduced Size of Liquefaction Necrosis of Mitral Annular Calcification in Chronic Renal Failure by Using Low Calcium Concentration Hemodialysis

et al. 1999

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itral annular calcification is a degenerative process that is commonly seen in the elderly, especially in women, and is usually recognized on Mmode and 2-dimensional echocardiography as a dense echo band moving parallel with the left ventricular free wall beneath the posterior mitral leaflet. 1,2 Chronic renal failure is one of the predisposing factors of this condition. 1,3 We report a case of liquefaction necrosis of a mitral annular calcification mimicking an intracardiac tumor, 4-8 in which both gallium-67 ( 67 Ga)-citrate and technetium-99m-methylene diphosphate ( 99m Tc-MDP) uptake was noted, in a patient with chronic renal failure that had been managed by hemodialysis for 11 years. The size of the liquefaction necrosis was reduced with low calcium concentration hemodialysis. Case ReportAn asymptomatic 58-year-old woman who had been on hemodialysis for 11 years because of chronic renal failure came to hospital for examination of an abnormal intracardiac mass, which had been found incidentally during an annual echocardiographic examination, and which had not been seen the year before. The patient's blood pressure was 126/72 mmHg. The heart rate was 76 beats/min with regular rhythm. The fourth heart sound and a grade 3/6 systolic ejection murmur were heard at the apex. Slightly anemic conjunctivae, dry skin and mildly distended abdomen due to ascites were seen. Laboratory studies were as follows: red blood cell count 367×10 4 /mm 3 , hemoglobin 11.3 g/dl, C-reactive protein <0.3 mg/dl, blood sugar 86 mg/dl, serum cholesterol 222 mg/dl, blood urea nitrogen 40 mg/dl, creatinine 7.1 mg/dl, calcium 2.4 mmol/L, phosphorus 2.7 mmol/L, alkaline phosphatase 308 U/L and the intact parathyroid hormone level 888 pg/ml. The patient had been given calcium carbonate and erythropoietin to correct the hypocalcemia and anemia, and pulse therapy of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) had also been performed for secondary hyperparathyroidism approximately 6 months before presentation.Transthoracic echocardiography demonstrated an echogenic 2.0×2.0×2.0 cm spherical mass with an internal echolucent area at the base of the posterior mitral leaflet and the lateral portion of the mitral annulus (Fig 1 a,b). No mitral regurgitation on Doppler color flow mapping was seen and there was normal left ventricular wall motion, although a small amount of pericardial effusion was noted.A high-density mass was observed at the base of the posterior mitral leaflet on computed tomography (CT) and a low-intensity mass was observed in the same area on magnetic resonance imaging (MRI) using the field echo technique; both these masses were compatible with calcification (Fig 2). Single photon emission CT with 67 Ga-citrate (Fig 3) and 99m Tc-MDP scintigraphy (Fig 4) revealed focal uptake at the same site as the spherical mass seen on echocardiography. Parathyroid scintigraphy by subtraction of thallium-201-chloride and 99m Tc-pertechnetate scan revealed 4 hypertrophied parathyroids compatible with secondary hyperparathyroidism due to chronic ...

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Sterile, caseous mitral anular abscess

Cited by 57 publications

References 3 publications

Caseous calcification of the mitral annulus: A multi-modality imaging perspective

Caseous calcification of the mitral annulus: A multi-modality imaging perspective

Caseous mitral annular calcifications: Multimodality imaging characteristics

Reduced Size of Liquefaction Necrosis of Mitral Annular Calcification in Chronic Renal Failure by Using Low Calcium Concentration Hemodialysis

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