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Updated: Jun 11, 2026
Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
[Tumours of the heart: diagnostic dilemma]
Insights
Mitral annular calcification can mimic tumors, requiring precise diagnosis before surgery. This case highlights a patient successfully treated for a suspected tumor that was actually calcification with infection.
Area of Science:
- Cardiology
- Pathology
Background:
- Mitral annular calcification (MAC) is a common degenerative process affecting the mitral valve apparatus, primarily the posterior leaflet.
- It is particularly prevalent in elderly individuals.
Observation:
- A 66-year-old woman presented with shortness of breath and palpitations.
- Echocardiography revealed a mass in the posterior mitral annulus, causing severe mitral regurgitation, mimicking a tumor.
Findings:
- Surgical exploration identified caseous material, which was aspirated and sent for analysis.
- Bacteriology confirmed Staphylococcus spp. infection; histopathology was nonspecific.
- Post-surgery, imaging confirmed the absence of the mass, and a bioprosthetic valve was implanted.
Implications:
- Mitral annular calcification can present as a diagnostic challenge, often imitating cardiac tumors.
- Accurate pre-operative diagnostics are crucial to differentiate MAC from actual neoplasms.
- Prompt identification and treatment of superimposed infections in MAC are vital for successful patient outcomes.
Introduction:
Mitral annular calcification is a degenerative process of the fibrosus support structure of the mitral apparatus, usually spreading over the posterior mitral leaflet.
Case Outline:
A 66-year-old woman with shortness of breath and palpitations was referred to our institution. Echocardiography showed a round, echo-dense mass, resembling a tumour, in the posterior mitral annulus, with the third degree mitral regurgitation. Based on the findings, surgical treatment was suggested involving removal of the tumour and correction of mitral valve insufficiency. During surgery the posterior annulus was incised, whitish caseous material was aspirated and the developed cavity was closed. A bioprosthetic valve was placed in the mitral position.The aspirated material was sent to bacteriological and histological analysis. Eight days after surgery control echocardiography and CT scan of the heart showed absence of the mass. Pathohistological finding was nonspecific. Bacteriology showed Staphylococus spp. Thirteen days after surgery the patient was discharged in stabile condition.
Conclusion:
Mitral annular calcification is a common degenerative disorder particularly in elderly persons. As the diagnosis very often remains unrecognised imitating a tumor formation, precise diagnostics is necessary before possible surgery.
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