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Images in Cardiovascular Medicine: Caseous Calcification of the Mitral Annulus
Author(s) -
Pugliatti Pietro,
Piccione Maurizio Cusmà,
Ascenti Giorgio,
Germanò Antonino,
Recupero Antonino,
Oreto Giuseppe,
Carerj Scipione
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12033
Subject(s) - medicine , transthoracic echocardiogram , transesophageal echocardiogram , radiology , cardiology , thrombus , mitral regurgitation , mitral valve , asymptomatic , sinus rhythm , calcification , acoustic shadow , mitral annulus , atrial fibrillation , ultrasound , diastole , blood pressure
A 78‐year‐old woman was admitted to our emergency department for subarachnoid hemorrhage. Since a month ago, she was taking warfarin after diagnosis, on transthoracic echocardiogram ( TTE ), of a suspected large atrial thrombus. The patient, referred to our institution for further investigation, presented asymptomatic; electrocardiogram showed sinus rhythm. TTE revealed an echo dense spherical mass located in the mitral periannular posterior region with moderate mitral regurgitation. Transesophageal echocardiography and cardiac computed tomography confirmed a calcified round mass (2.0 × 2.9 cm) with central areas of echolucency‐like liquefaction surrounded by a hyperechogenic structure without systolic flow inside the cavity. The mass was diagnosed as caseous calcification of the mitral annulus ( CCMA ), a rare finding associated with a benign prognosis, requiring surgery only in the presence of mitral valve dysfunction. The diagnosis of CCMA is, often, misconstrued as thrombus, tumor, or abscess, leading to unnecessary investigations or interventions. Our patient was discharged after discontinuation of warfarin.