Key result
Multimodality imaging successfully identifies a large septal dystrophic calcification mimicking a cardiac tumor.
Case Report (n=1)
Multimodality imaging is essential for accurately characterizing unusual myocardial masses, such as dystrophic calcifications mimicking cardiac tumours.
May support multimodality imaging for atypical myocardial masses; leaves open validation in larger cohorts before routine adoption.
Myocardial calcifications represent a rare type of myocardial pathology with a wide range of imaging appearances, from focal deposits to diffuse myocardial involvement. Two types of myocardial calcifications are usually recognized. Dystrophic calcifications represent the sequelae of local tissue damage like degeneration or necrosis. Metastatic calcifications arise as the consequence of calcium homeostasis impairment associated with hypercalcaemia. We describe an unusual case of dystrophic myocardial calcification mimicking tumour of the interventricular septum (IVS). A 67-year-old lady with a history of atrial fibrillation, arterial hypertension, and chronic heart failure underwent transthoracic echocardiography. In addition to concentric remodelling of the non-dilated left ventricle with preserved ejection fraction and left atrial dilatation, the examination unexpectedly revealed rounded and well-circumscribed hyperechogenic pathological mass (17 × 15 mm) in the basal segment of the anteroseptum (Panel A, Supplementary data online, Video S1). To better clarify its nature, cardiac magnetic resonance imaging was performed demonstrating a hypointense character of the mass on T1 (Panel B, Supplementary data online, Video S2) as well as on T2 weighted images with absence of late gadolinium enhancement. To confirm the suspicion of a bulky myocardial calcification, cardiac computed tomography (CT) was indicated. On unenhanced (Panel C) and contrast-enhanced CT images (Panels D and E), a large calcified mass continuous with the cardiac skeleton (mitral annulus and aortic root) and basal part of the IVS was clearly shown. As subsequent laboratory examination ruled out a disorder of calcium metabolism, we believe that the pathological mass of the IVS corresponds to dystrophic calcification probably linked to traumatic damage of the myocardium associated with the progression of cardiac skeleton calcification. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
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Kuchynka et al. (2020) conducted a case report in Dystrophic myocardial calcification mimicking cardiac tumour (n=1). Multimodality imaging (echocardiography, CMR, cardiac CT) was evaluated on Diagnosis of the cardiac mass. Multimodality imaging including echocardiography, cardiac magnetic resonance, and computed tomography successfully identified a large dystrophic calcification of the interventricular septum mimicking a cardiac tumour.
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