Caseous calcification of the mitral annulus is an infrequent echocardiographic finding. The differential diagnosis includes other entities like tumors, abscess or thrombus. Both cardiac CT and cardiac MRI may be useful for its definitive diagnosis.
La calcificación caseosa del anillo mitral es un hallazgo ecocardiográfico poco frecuente. Debe hacerse el diagnóstico diferencial con otras entidades tales como tumores, abscesos o trombos. Para su diagnóstico definitivo además del ecocardiograma tanto el TC cardiaco como la Cardio RM pueden ser de utilidad.
A 69-year-old woman with morbid obesity and positive blood cultures for Streptococcus agalactiae was subjected to echocardiographic analysis. It revealed a caseous calcification (CC) of the mitral annulus and mobile images attached to it. Transesophageal study confirmed endocarditis without mitral regurgitation (Fig. 1A–D). Antibiotic treatment was successful.
(A) Transthoracic echocardiogram showing a 2.5cm×1.5cm echolucent, crescent-shaped, semilunar mass in the posterior mitral annulus. Caseous calcification of the mitral valve was diagnosed. (B) Transesophageal echocardiogram showing mobile images attached to the mitral annulus (arrow). (C) Transesophageal echocardiogram color Doppler without mitral regurgitation. (D) 3D images showing the CC of the annulus and the vegetations. Differential diagnosis with an abscess was fundamental as treatment would have been completely different (medical treatment vs. surgery).
CC occurs in less than 0.07% of patients who undergo echocardiography. It can be misdiagnosed with other entities such as tumors and thrombus in cases like the one we report, it can be also misdiagnosed with an abscess. Other techniques such as cardiac CT or MRI are very useful to confirm this rare diagnosis; in our patient, morbid obesity prevented the use of further diagnostic tools.1,2
FundingThere was no funding for this job.
Conflict of interestsAuthors do not have any conflict of interests.