Key result
A multi-modality imaging approach successfully confirmed the benign diagnosis of caseous calcification of the posterior mitral annulus, avoiding an invasive diagnostic procedure.
Case Report (n=1)
Multi-modality imaging is useful for the early recognition and diagnosis of caseous calcification of the mitral annulus, avoiding unnecessary invasive diagnostic approaches.
May facilitate non-invasive diagnosis of caseous mitral annular calcification; leaves open prospective validation before broader adoption.
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. 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 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.
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Ribeiro et al. (2012) conducted a case report in Caseous calcification of the mitral annulus (n=1). Multi-modality imaging (echocardiography, cardiac MRI, multislice CT) was evaluated on Diagnosis of caseous calcification of the posterior mitral annulus. A multi-modality imaging approach successfully confirmed the benign diagnosis of caseous calcification of the posterior mitral annulus, avoiding an invasive diagnostic procedure.