Harpaz D, Auerbach I, Vered Z, Motro M, Tobar A, Rosenblatt S
Heart Institute, E. Wolfson Medical Center, Holon, Israel.
J Am Soc Echocardiogr. 2001 Aug;14(8):825-31. doi: 10.1067/mje.2001.111877.
Mitral annular calcification is a common echocardiographic finding. Caseous calcification is a rare variant seen as a large mass with echolucencies that resembles a tumor, occasionally resulting in exploratory cardiotomy. The aim of this study was to assess the prevalence of caseous calcification of the mitral annulus, to evaluate patient characteristics and the echocardiographic variables for diagnosing this entity, and to describe the clinical outcome on follow-up of such patients.
Caseous calcification was defined as a large, round, echo-dense mass with smooth borders situated in the periannular region, with no acoustic shadowing artifacts and containing central areas of echolucencies resembling liquefaction. Eighteen patients were diagnosed by 2-dimensional echocardiography as having caseous calcification of the mitral annulus. One had calcification of the tricuspid annulus. Nine patients underwent transesophageal echocardiographic studies.
A typical finding of a round, sometimes semilunar, large, echo-dense, soft mass with central echolucencies seen on both transthoracic and in particular transesophageal echocardiography, resembling a periannular mass, was demonstrated. The mass was posteriorly located in all mitral patients. Transesophageal echocardiography added limited information. Three patients underwent mitral valve replacement. The operative findings were a solid mass adherent to the posterior portion of the mitral valve. Sectioning revealed a toothpaste-like, white, caseous material. Sixteen (84%) patients were treated conservatively. On follow-up of 3.8 +/- 2.4 years, 4 patients died of unrelated causes.
The characteristic appearance of a large, soft, echo-dense mass containing central areas of echolucencies resembling liquefaction at the posterior periannular region of the mitral valve on 2D echocardiography is compatible with the diagnosis of caseous abscess. Such a finding should not be confused with a tumor. Transesophageal echocardiography does not appear to contribute to the diagnosis. This rather impressive lesion appears to carry a benign prognosis.
二尖瓣环钙化是一种常见的超声心动图表现。干酪样钙化是一种罕见的变异类型，表现为具有类似肿瘤的无回声区的大肿块，偶尔需要进行开胸探查。本研究的目的是评估二尖瓣环干酪样钙化的患病率，评估患者特征及用于诊断该实体的超声心动图变量，并描述此类患者随访的临床结局。
干酪样钙化定义为位于瓣环周围区域的大的、圆形、回声密集且边界光滑的肿块，无声影伪像且包含类似液化的中央无回声区。18例患者经二维超声心动图诊断为二尖瓣环干酪样钙化。1例有三尖瓣环钙化。9例患者接受了经食管超声心动图检查。
经胸超声心动图尤其是经食管超声心动图显示出典型表现，即一个圆形、有时呈半月形、大的、回声密集的柔软肿块，中央有无回声区，类似瓣环周围肿块。所有二尖瓣患者的肿块均位于后方。经食管超声心动图提供的信息有限。3例患者接受了二尖瓣置换术。手术所见为一个附着于二尖瓣后部的实性肿块。切片显示为牙膏样白色干酪样物质。16例（84%）患者接受了保守治疗。在3.8±2.4年的随访中，4例患者死于无关原因。
二维超声心动图显示二尖瓣后瓣环周围区域有一个大的、柔软的、回声密集且包含类似液化的中央无回声区的特征性表现，符合干酪样脓肿的诊断。这种表现不应与肿瘤混淆。经食管超声心动图似乎对诊断没有帮助。这种相当显著的病变似乎预后良好。
