Jabi Shriki, MD, Assistant Professor, Department of Radiology, University of Southern California, Keck School of Medicine, 1200 N. State Street, D&T Rm 3D321, Los Angeles, CA 90033, United States. jshriki@gmail.com
Article-Type of This Article
Case Report
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Jabi Shriki, Christine Rongey, Bobby Ghosh, Samuel Daneshvar, Partick M Colletti, Ali Farvid, Alison Wilcox
Jabi Shriki, Partick M Colletti, Alison Wilcox, Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, California, CA 90012, United States
Christine Rongey, Bobby Ghosh, University of Southern California, Keck School of Medicine, Los Angeles, CA 90012, United States
Samuel Daneshvar, Ali Farvid, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA 90012, United States
Author contributions: Shriki J served as the primary author and wrote and finalized the manuscript; Rongey C and Ghosh B researched and wrote the clinical histories of the patients presented; Daneshvar S obtained echocardiographic images and contributed to the sections of the manuscript discussing the echocardiographic appearance of caseous mitral annular calcifications; Colletti PM contributed to the discussion regarding the cardiac MR findings in the patients who were discussed; Farvid A assisted in the discussion of the clinical significance of mitral annular calcifications, and obtained IRB approval for this review; Wilcox A assisted in editing and finalizing the manuscript.
Correspondence to: Jabi Shriki, MD, Assistant Professor, Department of Radiology, University of Southern California, Keck School of Medicine, 1200 N. State Street, D&T Rm 3D321, Los Angeles, CA 90033, United States. jshriki@gmail.com
Telephone: +1-323-2267257 Fax: +1-323-4428550
Received: February 24, 2010 Revised: March 24, 2010 Accepted: April 1, 2010 Published online: April 28, 2010
Abstract
The authors report herein a series of 3 patients with caseous mitral annular calcifications (MAC). One of the patients presented with mass-like, caseous MAC as an incidental finding on a staging computed tomography (CT) for metastatic colorectal carcinoma. Another patient presented with a nodule on a chest radiograph, which was later found on CT to be due to caseous MAC. In the third patient, caseous MAC was initially detected on echocardiography, and was further evaluated with CT and cardiac magnetic resonance imaging. In all three patients, the appearances posed a diagnostic dilemma. The appearance of caseous MAC is dissimilar to non-caseous MAC and is usually seen as an ovoid, mass-like structure, with homogeneous hyperattenuation, representing a liquefied form of calcium and proteinaceous fluid. This homogeneous center is surrounded by peripheral, shell-like calcifications. Caseous MAC is likely an under-recognized entity and may present a diagnostic dilemma at CT, magnetic resonance imaging, or echocardiography.
