Tumor-Like Calcification of the Mitral Annulus
Diagnosis With Multislice Computed Tomography
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.
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.
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.
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.
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