Caseous calcification of the mitral annulus imaged with 64-slice multidetector CT and magnetic resonance imaging

  • Olivier M. Vanovermeire
  • André J. Duerinckx
  • David A. Duncan
  • Wilson G. Russell
Case Report


Caseous calcification of the mitral annulus is a rare entity in cardiac imaging. We present CT and magnetic resonance imaging (MRI) in a patient evaluated for severe mitral valve regurgitation with such calcified cardiac mass in the thickened basal wall of the left ventricle. Despite good visualization of the mass both with 64-slice multidetector CT and MRI, the characterization of the lesion was difficult. The most critical finding was the presence of a hyperdense mass with an even denser peripheral rim on pre-contrast CT images. The mass did not enhance after X-ray contrast agent administration. We discuss the preoperative differential for calcified intramyocardial mass.

Key words:

caseous calcification computed tomography magnetic resonance myocardial calcification myocardial mass myocardium 


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  1. 1.
    Isaacs D, Stark P, Nichols C, Antevil J, Shabetai R. (2003). Post-traumatic pericardial calcification. J Thorac Imaging 18(4):250–253PubMedCrossRefGoogle Scholar
  2. 2.
    Bloomfield P, Schoen FJ, Force T, Khuri S, and Parisi AF. (1986). Calcified left atrial mass associated with mitral valve prolapse. Am Heart J 111(6):1205–1207PubMedCrossRefGoogle Scholar
  3. 3.
    Basso C, Valente M, Poletti A, Casarotto D, Thiene G. (1997). Surgical pathology of primary cardiac and pericardial tumors. Eur J Cardiothorac Surg 12(5):730–737 discussion 737–738PubMedCrossRefGoogle Scholar
  4. 4.
    Rendon F, Agosti J, Llorente A, Rodrigo D, Montes K. (2002). Intramural cardiac myxoma in left ventricular wall: an unusual location. Asian Cardiovasc Thorac Ann 10(2):170–172PubMedGoogle Scholar
  5. 5.
    Klein GJ, Kostuk WJ, Black L, Ahuja SP. (1978). Calcification in an intramyocardial mass lesion: isolated calcification of an accessory papillary muscle in a patient with mitral prolapse. Cathet Cardiovasc Diagn 4(1):91–95PubMedCrossRefGoogle Scholar
  6. 6.
    Nowrangi SK, Ammash NM, Edwards WD, Breen JF, Edmonson JH. (2000). Calcified left ventricular mass: unusual clinical, echocardiographic, and computed tomographic findings of primary cardiac osteosarcoma. Mayo Clin Proc 75(7):743–747PubMedCrossRefGoogle Scholar
  7. 7.
    Ben-Hamda K, Maatouk F, Ben-Farhat M, Betbout F, Gamra H, Addad F, et al. (2003) Eighteen-year experience with echinococcosus of the heart: clinical and echocardiographic features in 14 patients. Int J Cardiol 91(2-3):145–151PubMedCrossRefGoogle Scholar
  8. 8.
    Soler-Soler J, Romero-Gonzalez R. (1975). Calcified intramural fibroma of the left ventricle. Eur J Cardiol 3(1):71–73PubMedGoogle Scholar
  9. 9.
    Waaler PE, Svendsen S, Halvorsen JF. (1972). Intramural calcified fibroma of the heart. Acta Paediatr Scand 61(2):217–222PubMedCrossRefGoogle Scholar
  10. 10.
    Beghetti M, Haney I, Williams WG, Mawson J, Freedom RM, Gow RM. (1996). Massive right ventricular fibroma treated with partial resection and a cavopulmonary shunt. Ann Thorac Surg 62(3):882–884PubMedGoogle Scholar
  11. 11.
    Burke AP, Rosado-de-Christenson M, Templeton PA, Virmani R. (1994). Cardiac fibroma: clinicopathologic correlates and surgical treatment. J Thorac Cardiovasc Surg 108(5):862–870PubMedGoogle Scholar
  12. 12.
    Sommer K, Lajos TZ, Visco JP. (1992). Intramyocardial calcification in the elderly. A diagnostic and therapeutic puzzle. Chest 102(1):317–319PubMedCrossRefGoogle Scholar
  13. 13.
    Novaro GM, Griffin BP, Hammer DF. (2004). Caseous calcification of the mitral annulus: an underappreciated variant. Heart 90(4):388PubMedCrossRefGoogle Scholar
  14. 14.
    Harpaz D, Auerbach I, Vered Z, Motro M, Tobar A, and Rosenblatt S. (2001). Caseous calcification of the mitral annulus: a neglected, unrecognized diagnosis. J Am Soc Echocardiogr 14(8):825–831PubMedCrossRefGoogle Scholar
  15. 15.
    Albanese Filho FM, de Oliveira AV, Abrahao JL, Lopes AS, Brandao AP, Jasbik W, et al. (1980). Caseous granuloma of the heart simulating a tumor. Arq Bras Cardiol 35(3):231–234PubMedGoogle Scholar
  16. 16.
    Gilbert HM, Grodman R, Chung MH, Hartman G, Krieger KH, Hartman BJ. (1997). Sterile, caseous mitral valve “abscess” mimicking infective endocarditis. Clin Infect Dis 24(5):1015–1016PubMedGoogle Scholar
  17. 17.
    Alkadhi H, Leschka S, Pretre R, Perren A, Marincek B, Wildermuth S. (2005). Caseous calcification of the mitral annulus. J Thorac Cardiovasc Surg 129(6):1438–1440PubMedCrossRefGoogle Scholar
  18. 18.
    Gramenzi S, Mazzola AA, Tagliaferri B, Protasoni G, Brusoni D, d’Aloya G, et al. (2005). Caseous calcification of the mitral annulus: unusual case of spontaneous resolution. Echocardiography 22(6):510–513PubMedCrossRefGoogle Scholar
  19. 19.
    Tatli S, Lipton MJ. (2005). CT for intracardiac thrombi and tumors. Int J Cardiovasc Imaging 21(1):115–131PubMedCrossRefGoogle Scholar
  20. 20.
    Vander Salm TJ. (2000). Unusual primary tumors of the heart. Semin Thorac Cardiovasc Surg 12(2):89–100PubMedGoogle Scholar
  21. 21.
    Ceithaml EL, Midgley FM, Perry LW, Dullum MK. (1990). Intramural ventricular fibroma in infancy: survival after partial excision in 2 patients. Ann Thorac Surg 50(3):471–472PubMedCrossRefGoogle Scholar
  22. 22.
    Cho JM, Danielson GK, Puga FJ, Dearani JA, McGregor CG, Tazelaar HD, et al. (2003). Surgical resection of ventricular cardiac fibromas: early and late results. Ann Thorac Surg 76(6):1929–1934PubMedCrossRefGoogle Scholar
  23. 23.
    Inamura S, Iwasaki M, Koide S, Shohtsu A, Kanemoto N. (1993). Successful excision of a left ventricular fibroma in an adult patient. Kyobu Geka 46(7):626–629PubMedGoogle Scholar
  24. 24.
    Yoshimura Y, Nakayama S, Oiwa H, Noma S, Nakamoto M, Katori T, et al. (1998). Successful removal of a left ventricular fibroma in a 10-year-old patient. Kyobu Geka 51(12):1043–1046PubMedGoogle Scholar
  25. 25.
    Padalino MA, Basso C, Milanesi O, Vida VL, Moreolo GS, Thiene G, et al. (2005). Surgically treated primary cardiac tumors in early infancy and childhood. J Thorac Cardiovasc Surg 129(6):1358–1363PubMedCrossRefGoogle Scholar
  26. 26.
    Valente M, Cocco P, Thiene G, Casula R, Poletti A, Milanesi O, et al. (1993). Cardiac fibroma and heart transplantation. J Thorac Cardiovasc Surg 106(6):1208–1212PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Olivier M. Vanovermeire
    • 1
  • André J. Duerinckx
    • 2
  • David A. Duncan
    • 3
  • Wilson G. Russell
    • 4
  1. 1.Department of RadiologyAZ GroeningeKortrijkBelgium
  2. 2.Forsyth Radiological AssociatesWinston-SalemUSA
  3. 3.Cardiac and Thoracic SurgeryForsyth Medical CenterWinston-SalemUSA
  4. 4.Department of PathologyForsyth Medical CenterWinston-SalemUSA

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