The Mysterious Mass in Cardiac Chamber
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Abstract
A 61-year-old woman presented with dyspnea on exertion. Her vital signs and physical examination findings were normal. Basic laboratory results were within normal limits. She underwent an echocardiogram to evaluate cardiac function. A transthoracic echocardiogram revealed a cystic mass attached to the posterior annulus of the mitral valve. Cardiac magnetic resonance imaging (CMR) was performed to detect residual myocardial ischemia and confirmed the diagnosis of caseous calcification of the mitral annulus, measuring 2 × 2.6 cm.
In this case, coronary angiography revealed multivessel disease with a mass-like blood supply shadow on the cineangiography view. She was scheduled for surgical revascularization as soon as possible.
Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification (MAC), a chronic degenerative process that typically occurs in elderly patients, particularly women. Hypertension, chronic kidney disease (CKD), and altered calcium-phosphate metabolism are also associated with this condition1. CCMA is observed in approximately 0.067% of all echocardiographic examinations and is present in 0.63% of all patients with MAC2. The mass-like calcification should be included in the differential diagnosis of cardiac masses when determining treatment options.
Caseous calcification is commonly asymptomatic; therefore, unnecessary treatment should be avoided, and monitoring the patient's progress is recommended in most cases3. Rarely, caseous calcification may cause mitral valve regurgitation, fistula formation, or systemic embolization4, in which case surgical removal of the mass should be considered.
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- เนื้อหาและข้อมูลในบทความที่ลงพิมพ์กับวารสารโรคหัวใจและทรวงอกถือเป็นข้อคิดเห็น และความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสารไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใด ๆ
- บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวารสารสถาบันโรคทรวงอกถือเป็นลิขสิทธิ์ของวารสารวิชาการ หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่ง ส่วนใดไปเผยแพร่ กรุณาอ้างอิงบทความนั้น ๆ
References
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Fujiwara M, Hatani Y, Fujimoto W, Yamashita S, Imanishi J, Iwasaki M, et al. Three cases of caseous calcification of the mitral annulus resulting in spontaneous fistulation CASE (Phila). 2022;6(8): 355-60.
