Dynamic nature of caseous mitral annular calcification.
Dynamic nature of caseous mitral annular calcification.
复制标题
干酪样二尖瓣环钙化的动态性质。
DOI：
10.1016/j.jcct.2018.05.012
复制
发表时间：
2018
影响因子：
5.4
通讯作者：
Chen,MarcusY
中科院分区：
文献类型：
--
作者：
Groves,DanielW;Acharya,Tushar;Shanbhag,SujataM;Bandettini,WPatricia;Arai,AndrewE;Chen,MarcusY
一位71岁的高脂血症吸烟者被转诊为经胸超声心动图上显示的累及二尖瓣后环的大回声致密肿块。他最初接受了心脏磁共振成像研究。电影成像显示一个边界清楚的肿块(黄色箭头)附着在二尖瓣后叶底部(图1，图A)。在T2加权成像上，包括快速自旋回波(图1，面板B)，肿块为暗影。在晚期Gd增强成像中，可见明亮的强化边缘和以暗为主的核心(图1，面板C)。鉴别包括血栓形成的冠状静脉窦、严重的二尖瓣环钙化(MAC)和干酪性MAC。患者接受心脏计算机断层扫描(CT)以进一步确定肿块的特征。心脏CT在平扫(图2，面板A和B)和增强图像(图2，面板C和D)上显示二尖瓣环内均一高密度的肿块，Hounsfield单位(HU)大于600。虽然高密度是钙化的证据，但肿块的卵圆形形状及其均质性在典型的二尖瓣环钙化中是不寻常的，并提示存在干酪性MAC，它被描述为“牙膏状、乳白色、干酪质物质”，被“大的、不可折叠的钙化包膜”包围。1患者保持无症状，没有栓子事件。四年后的经胸超声心动图显示二尖瓣环肿块内有一个回声透明的核心。患者接受了重复的心脏CT检查，显示中心区域密度较低(HU<50)，仅有一外周缘。
A 71-year-old former smoker with hyperlipidemia was referred for evaluation of a large echodense mass involving the posterior mitral annulus visualized on a transthoracic echocardiogram. He initially underwent a cardiac magnetic resonance imaging study. A well-circumscribed mass (yellow arrow) attached to the base of the posterior mitral valve leaflet was visualized on cine imaging (Figure 1, Panel A). The mass was dark on T2-weighted imaging including turbo-spin echo (Figure 1, Panel B). On late-gadolinium enhancement imaging, there was a bright rim of enhancement with a predominantly dark core (Figure 1, Panel C). The differential included thrombosed coronary sinus, severe mitral annular calcification (MAC), and caseous MAC. The patient was referred for cardiac computed tomography (CT) to further characterize the mass.The cardiac CT demonstrated a mass in the posterior mitral annulus that was uniformly hyperdense, Hounsfield unit (HU) greater than 600 on the non-contrast (Figure 2, Panels A and B) and contrast images (Figure 2, Panels C and D). While the high density was evidence of calcification, the ovoid shape of the mass and its homogeneity was unusual for typical mitral annular calcification and suggested presence of caseous MAC, which has been described as “toothpaste-like, milky, caseous material” surrounded by a “large, calcified envelope that is non-collapsible.” 1 The patient remained asymptomatic without an embolic event. A transthoracic echocardiogram four years later demonstrated an echolucent core in the mitral annular mass. The patient underwent a repeat cardiac CT that showed a central area of lower density attenuation (HU less than 50) with only a peripheral rim of