EURORAD ESR

Case 14104

Caseous calcification of the mitral valve annulus

Author(s)
Emad Moussa (M.S., FRCR, M.D.), Ahmed Munier (M.S., M.D.)

Al Noor hospital;
Airport road
009712 Abu Dhabi;
Email:Emoussa@alnoorhospital.com
 
Patient
female, 56 year(s)
 
 
  • Figure 1
    Transthoracic echocardiography

    Echocardiography showed large echogenic mass lesion involving the mitral annulus and possibly extending to the left atrial lumen.

     
    Area of Interest: Cardiovascular system; Imaging Technique: Echocardiography; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    Axial CT chest without contrast

    Axial CT chest before contrast adminstration showed large dense calcified mass lesion of the mitral valve.

     
    Area of Interest: Cardiac; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Connective tissue disorders;
     
     
  • Figure 3
    MRI cardiac axial T2 *

    Axial T2* CMR demonstrates blooming effets related to the heavy calcifications of the lesion.

     
    Area of Interest: Cardiovascular system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Artefact;
     
     
  • Figure 4
    Axial CMR 4 chamber view

    Axial CMR bright blood 4 chamber view of the heart demonstrates mitral valve dysfunction sequel to the valve annulus mass with subsequent regurgitation seen as aliasing during ventricle contraction.

     
    Area of Interest: Cardiovascular system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Artefact;
     
     
  • Figure 5
    Two chamber view CMR

    Sagittal two chamber view of the heart with involvement of the mitral valve posterior commissure.

     
    Area of Interest: Cardiac; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Connective tissue disorders;
     
     
  • Figure 6
    Delayed enhancement CMR sagittal view

    Delayed enhancement CMR sagittal view demonstrates intense enhancement of the periphery of the mass lesion at the posterior commissure of mitral valve as compared to the completely nulled myocardium.

     
    Area of Interest: Cardiovascular system; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Connective tissue disorders;
     
     
  • Figure 7
    Intraoperative image

    Exploration of the mitral annulus surface demonstrates expansion by whitish toothpaste-like material.

     
    Area of Interest: Cardiac; Imaging Technique: Teleradiology; Procedure: Observer performance; Special Focus: Connective tissue disorders;
     
     
  • Figure 8
    Post operative CT brain

    Post operative CT brain following surgical mitral annulus debridement and valve replacement demonstrates multiple cerebral lacunar infarcts.

     
    Area of Interest: Neuroradiology brain; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Acute;
     
     
Echocardiography showed large echogenic mass lesion involving the mitral annulus and possibly extending to the left atrial lumen.
 
Axial CT chest before contrast adminstration showed large dense calcified mass lesion of the mitral valve.
 
Axial T2* CMR demonstrates blooming effets related to the heavy calcifications of the lesion.
 
Axial CMR bright blood 4 chamber view of the heart demonstrates mitral valve dysfunction sequel to the valve annulus mass with subsequent regurgitation seen as aliasing during ventricle contraction.
 
Sagittal two chamber view of the heart with involvement of the mitral valve posterior commissure.
 
Delayed enhancement CMR sagittal view demonstrates intense enhancement of the periphery of the mass lesion at the posterior commissure of mitral valve as compared to the completely nulled myocardium.
 
Exploration of the mitral annulus surface demonstrates expansion by whitish toothpaste-like material.
 
Post operative CT brain following surgical mitral annulus debridement and valve replacement demonstrates multiple cerebral lacunar infarcts.
 
 
 
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