EURORAD ESR

Case 14091

Caseous calcification as a cause of heart failure evaluated by multimodality imaging

Author(s)
Shaun Hinen, BS1; David D Daly Jr., MD2; Daniel H. Steinberg, MD2;
U. Joseph Schoepf, MD1, 2; Damiano Caruso, MD1, 3

1 Division of Cardiovascular Imaging,
Department of Radiology and Radiological Science,
Medical University of South Carolina, Charleston, SC
2 Division of Cardiology,
Department of Medicine,
Medical University of South Carolina, Charleston, SC
3 Department of Radiological Sciences,
Oncology and Pathology,
University of Rome "Sapienza", Rome, Italy
 
Patient
male, 77 year(s)
 
 
  • Figure 1
    Transthoracic Echocardiogram

    Apical four chamber echocardiogram still image with large echogenic mass located in the interventricular septum. There is also evidence of significant mitral annular calcification.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Echocardiography; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;
     
     
  • Figure 2
    Cardiac Computed Tomography Angiography
     

    Non-contrast Cardiac gated CT axial view shows diffuse calcification of the mitral annulus (arrow), with extension into the aortic valve and interventricular septum.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Contrast-enhanced cardiac CT long-axis 2 chambers multiplanar reconstruction (MPR) confirms the massive calcification of the mitral annulus (arrow).

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    Contrast-enhanced cardiac CT short-axis multiplanar reconstruction (MPR) shows the massive calcification and myxomatous degeneration of the mitral annulus (arrow).

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;

    3D volume rendering confirms size/location of mitral mass.

     
    Area of Interest: Cardiovascular system; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Calcifications / Calculi;
     
     
  • Figure 3
    Fluoroscopy
     

    Right anterior oblique/cranial left heart catheterization supported the presence of the intracardiac mass (white arrows).

     
    Area of Interest: Cardiovascular system; Imaging Technique: Fluoroscopy; Procedure: Catheters; Special Focus: Calcifications / Calculi;

    Posterior anterior/central view left heart catheterization shows the calcified mass (white arrows).

     
    Area of Interest: Cardiovascular system; Imaging Technique: Fluoroscopy; Procedure: Catheters; Special Focus: Calcifications / Calculi;
     
     
Apical four chamber echocardiogram still image with large echogenic mass located in the interventricular septum. There is also evidence of significant mitral annular calcification.
 
Non-contrast Cardiac gated CT axial view shows diffuse calcification of the mitral annulus (arrow), with extension into the aortic valve and interventricular septum.
 
Contrast-enhanced cardiac CT long-axis 2 chambers multiplanar reconstruction (MPR) confirms the massive calcification of the mitral annulus (arrow).
 
Contrast-enhanced cardiac CT short-axis multiplanar reconstruction (MPR) shows the massive calcification and myxomatous degeneration of the mitral annulus (arrow).
 
3D volume rendering confirms size/location of mitral mass.
 
Right anterior oblique/cranial left heart catheterization supported the presence of the intracardiac mass (white arrows).
 
Posterior anterior/central view left heart catheterization shows the calcified mass (white arrows).
 
 
 
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