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(Circulation. 2003;107:355.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Tumor-Like Calcification of the Mitral Annulus

Diagnosis With Multislice Computed Tomography

G. Morgan-Hughes, BM, BS; L. Zacharkiw, CCSO; C. Roobottom, BM, BS; A.J. Marshall, MD

From the South West Cardiothoracic Centre, Plymouth NHS Trust, Derriford, Plymouth, United Kingdom.

Correspondence to G.J. Morgan-Hughes, SpR Cardiology, Cardiology Department, SWCC, Plymouth NHS Trust, Derriford, Plymouth PL6 8DH, UK. E-mail hughesgj{at}talk21.com

An 83-year-old woman underwent transthoracic echocardiography (TTE) to assess her left ventricular systolic function. The TTE showed a large, round, echo-dense mass with central echo-lucencies resembling a posterior periannular tumor.

There was no associated mitral valvular dysfunction, and left ventricular function was good. Further assessment was performed using electrocardiographic-gated cardiac multislice computed tomography. This demonstrated that the mass seen on TTE was due to gross calcification of the posterior portion of the mitral valve annulus (Figures 1 through 3). Unlike symmetrical mitral annular calcification, asymmetri- cal tumor-like calcification of the mitral annulus is a rare and often unrecognized condition.

View larger version (165K): [in this window] [in a new window]   Figure 1. Multislice computed tomography of the heart. A 3-dimensional image, generated using volume rendering techniques, is seen in axial section at posterior mitral valve annulus level, showing the left atrium and an oblique cross section of the left ventricle in continuity with the aorta. The posterior mitral valve annulus is replaced by a large calcified mass.

View larger version (137K): [in this window] [in a new window]   Figure 2. Calcified skeleton of the mitral valve annulus isolated by manipulation of the 3-dimensional data volume. There is marked asymmetry of the annular calcification (posterior is to the right and anterior to the left of the image).

View larger version (190K): [in this window] [in a new window]   Figure 3. Virtual angioscopy from the left atrium orientated toward the mitral valve (voyager) again, demonstrating the marked asymmetry of the mitral annular calcification.

Liquefaction necrosis of mitral annular calcification occurs in 3% of autopsied cases. Surgical findings in such cases reveal a pale caseous material that is culture-negative. It is not malignant, and surgery should be reserved for coexistent mitral valve lesions. The treatment in this case was conservative.

Acknowledgments

The authors are undertaking research into the clinical applications of cardiac computed tomography. The work is supported by a grant from the Royal College of Radiologists.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Morgan-Hughes, G. Articles by Marshall, A.J. Search for Related Content PubMed PubMed Citation Articles by Morgan-Hughes, G. Articles by Marshall, A.J. Related Collections Valvular heart disease CT and MRI