Korean Circ J.  2009 Feb;39(2):82-85. 10.4070/kcj.2009.39.2.82.

Two Cases of Caseous Calcification of the Mitral Annulus

• Byeon KM
• Park SW
• Choi JO
• Yang JH
• Han HJ
• Son GH
• Kim YJ

• KMID: 2297955
• DOI: http://doi.org/10.4070/kcj.2009.39.2.82

Abstract

Caseous mitral annular calcification describes a heavy calcification of the mitral annulus with central liquefaction. This rare variant of mitral annular calcification may resemble an intracardiac tumor, abscess, vegetation, or thrombus, a resemblance that often leads to unnecessary surgery. Typical echocardiographic findings include a large, round, bright echogenic mass with a central echolucent area. It is known to have a benign clinical outcome, and it is thus managed conservatively. Because this entity is not well known and has only rarely been described, we report two cases of mitral annular calcification encountered at our institution. The first patient was an elderly woman with exertional dyspnea who was found to have a solitary pulmonary nodule on plain chest radiography. This was determined to represent caseous calcification of the mitral annulus. The other patient was an elderly woman who had a history of cerebral embolic infarction. She did not have an intracardiac thrombus, but she did have caseous mitral annular calcification. Both patients were managed conservatively.

Keyword

Calcification, physiologic; Mitral valve

MeSH Terms

Abscess
Aged
Calcification, Physiologic
Dyspnea
Female
Humans
Infarction
Mitral Valve
Solitary Pulmonary Nodule
Thorax
Thrombosis
Unnecessary Procedures

Figure

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  Fig. 1 Plain chest radiograph (posteroanterior projection) shows a 23 mm-sized nodule in the left lower lung zone, retrocardiac area (arrow).

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  Fig. 2 Echocardiograph of case 1. A: parasternal long axis view shows a mitral annular calcification. B: zoomed image of the mitral valve shows a large, spherical echogenic mass with a smooth border. C: apical 2-chamber view of this calcified mass has a central echolucent area. D: color Doppler image shows no vascularity within the mass.

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  Fig. 3 Cardiac computed tomography. In the contrast-enhanced axial (A) and reconstructed volume rendering images (B), a dense calcified mass in the mitral annulus measuring 3.6×16×18 mm is shown. The coronary arteries are normal.

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  Fig. 4 Echocardiograph of case 2. Transthoracic echocardiography (A and B) and transesophageal echocardiography (C and D). A: parasternal long axis view of a spherical bright echogenic mass in the mitral annular area. B: parasternal short axis view of echogenic material around the mitral annular area. C: egg-shell like mass. D: color Doppler image shows mild mitral regurgitation and no significant flow communication between the central echolucent area and the cardiac chamber.

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