Key result
Multimodality imaging combining echo, MRI, and CT definitively diagnoses CMAC in all 6 patients.
Why the study?
Caseous mitral annular calcification (CMAC) mimics cardiac vegetation or abscess, making correct diagnosis essential to avoid unnecessary interventions, cardiac surgery, and psychological suffering.
Case Report (n=6)
No
Non-invasive multimodality imaging using Echo, MRI, and CT is effective for definitively diagnosing caseous mitral annular calcification and avoiding unnecessary surgical interventions.
May facilitate non-invasive diagnosis of caseous mitral annular calcification; hypothesis-generating and should not yet change practice.
BACKGROUND: Caseous mitral annular calcification (CMAC) is a rare liquefactive variant of mitral annular calcification (MAC) and superficially mimics a cardiac vegetation or abscess. CMAC is viewed as a benign condition of MAC, while MAC has clinical implications for patients' lives. Correctly diagnosing CMAC is essential in order to avoid unnecessary interventions, cardiac surgery or even psychological suffering for the patient. CASE PRESENTATION: We report on 6 patients with suspected intra-cardiac masses of the mitral annulus that were referred to our institution for further clarification. A definitive diagnosis of CMAC was achieved by combining echocardiography (Echo), cardiac magnetic resonance imaging (MRI) and cardiac computed tomography (CT) for these patients. Echo assessed the mass itself and possible interactions with the mitral valve. MRI was useful in differentiating the tissue from other benign or malign neoplasms. CT revealed the typical structure of CMAC with a "soft" liquefied centre and an outer capsule with calcification. CONCLUSION: CMAC is a rare condition, and most clinicians and even radiologists are not familiar with it. CMAC can be mistaken for an intra-cardiac tumour, thombus, vegetation, or abscess. Non-invasive multimodality imaging (i.e. Echo, MRI, and CT) helps to establish a definitive diagnosis of CMAC and avoid unnecessary interventions especially in uncertain cases.
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Sveric et al. (2022) conducted a case report in Caseous mitral annular calcification (CMAC) (n=6). Multimodality imaging (Echocardiography, MRI, CT) was evaluated on Definitive diagnosis of CMAC. Non-invasive multimodality imaging combining echocardiography, cardiac MRI, and cardiac CT successfully established a definitive diagnosis of caseous mitral annular calcification in all 6 patients.
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