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      Caseous calcification of the mitral annulus (CCMA) – A rare mimicker of a cardiac mass

      case-report
      Author(s): , Radiologist, MD Radiology a , * , , Radiologist, MD Radiology a , , Cardiologist, MD Cardiology b , , Cardiologist, MD Cardiology b
      Publication date (Electronic):
      Journal: Radiology Case Reports
      Publisher: Elsevier
      Keywords: Caseous calcification of mitral annulus, Cardiac MRI, Cardiac CT

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          Abstract

          Caseous calcification of the mitral annulus (CCMA) is a less common variant of mitral annulus calcification mimicking an intracardiac mass. The caseous calcification of the mitral annulus is a harmless benign entity that is an infrequent and incidental finding. Awareness about the condition is a must to avoid misinterpretations leading to unnecessary investigations and interventions. Therefore, here we present a case of CCMA diagnosed through different radiological modalities such as cardiac magnetic resonance imaging and multidetector computed tomography.

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          Multimodality cardiac imaging in the evaluation of mitral annular caseous calcification.

          Alison Duncan, Philip J Kilner, Sadaf Raza … (2011)
          Article 0 comments Cited 7 times – based on 0 reviews     Review now
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            Multimodality imaging assessment of a caseous calcification of the mitral valve annulus

            Imen Hamdi, Chadia Chourabi, Younes Arous … (2017)
            Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. Since it is a benign process, differentiating it from malignant intra-cardiac mass is primordial to avoid unnecessary surgery. Various imaging modalities can be complimentary for definitive diagnosis. We present a case of CCMA in a 71-year-old female patient. Her medical history revealed hypertension, diabetes mellitus, hyperlipidaemia and coronary artery disease. She was referred to our department for coronary catheterization because of angina symptoms upon minimal exertion. The lesion was detected during echocardiography and was defined as a mass of heterogeneous content with calcification points, located at the posterior side of the mitral valve annulus. Restricted motion of the posterior leaflet and the mass effect caused only minimal mitral regurgitation. To establish the correct diagnosis, we performed the full spectrum of noninvasive cardiac imaging modalities. Transesophageal echocardiography identified well-organized, composite lesion with regular edges, markedly calcified margins and more echolucent central portion. A computed tomography (CT) was performed, showing a hyperdense mass with hypodense center and a calcified peripheral rim located at the posterior mitral ring. Cardiac magnetic resonance imaging (MRI) showed that the mass was hypointense with respect to the myocardium in the T1 and T2-weighted sequences and only presented late-phase enhancement in the surrounding capsule. Based on the CT and MRI findings, the diagnosis of CCMA was established. The patient was managed conservatively.
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              Caseous Calcification of the Mitral Annulus

              Silvia Pradella, Silvia Verna, Gloria Addeo … (2019)
              Soft-tissue masses or mass-like lesions involving the mitral valve include a wide range of diseases such as tumors, abscesses, vegetations, thrombus and, rarely, caseous calcifications of the mitral annulus. Caseous calcifications of the mitral annulus is a rare variant of mitral annular calcification that is usually asymptomatic and diagnosed incidentally. Echocardiography is the first-choice imaging modality. Cardiac computed tomography is an ideal tool to confirm the presence of calcifications and caseous necrosis. In cases where there is doubt, cardiac magnetic resonance imaging may be used. We present the case of a 62-year-old patient with an intra-cardiac mass diagnosed by echocardiography. Imaging modalities to achieve a correct diagnosis and avoid unnecessary surgical intervention are discussed.
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                Author and article information

                Contributors
                Nirmal Prasad Neupane
                Journal
                Journal ID (nlm-ta): Radiol Case Rep
                Journal ID (iso-abbrev): Radiol Case Rep
                Title: Radiology Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 1930-0433
                Publication date PMC-release: 29 May 2022
                Publication date Collection: August 2022
                Publication date (Electronic): 29 May 2022
                Volume: 17
                Issue: 8
                Pages: 2677-2679
                Affiliations
                [a ]Radiologist, Department of Radiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
                [b ]Cardiologist, Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
                Author notes
                [* ]Corresponding author. nirmal.neup@ 123456gmail.com
                Article
                Publisher Item ID: S1930-0433(22)00329-6
                DOI: 10.1016/j.radcr.2022.04.042
                PMC ID: 9160408
                SO-VID: b8169f60-0fb0-4388-9e60-58cd3baf879d
                Copyright © © 2022 Published by Elsevier Inc. on behalf of University of Washington.
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 17 April 2022
                Date accepted : 24 April 2022
                Categories
                Subject: Case Report

                Keywords: caseous calcification of mitral annulus,cardiac mri,cardiac ct
                Data availability:
                Keywords: caseous calcification of mitral annulus, cardiac mri, cardiac ct

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