Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Fetscherstr. 76, 01307, Dresden, Germany.
Insitute and Polyclinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
BMC Med Imaging. 2022 Jan 6;22(1):7. doi: 10.1186/s12880-021-00725-x.
Caseous mitral annular calcification (CMAC) is a rare liquefactive variant of mitral annular calcification (MAC) and superficially mimics a cardiac vegetation or abscess. CMAC is viewed as a benign condition of MAC, while MAC has clinical implications for patients' lives. Correctly diagnosing CMAC is essential in order to avoid unnecessary interventions, cardiac surgery or even psychological suffering for the patient.
We report on 6 patients with suspected intra-cardiac masses of the mitral annulus that were referred to our institution for further clarification. A definitive diagnosis of CMAC was achieved by combining echocardiography (Echo), cardiac magnetic resonance imaging (MRI) and cardiac computed tomography (CT) for these patients. Echo assessed the mass itself and possible interactions with the mitral valve. MRI was useful in differentiating the tissue from other benign or malign neoplasms. CT revealed the typical structure of CMAC with a "soft" liquefied centre and an outer capsule with calcification.
CMAC is a rare condition, and most clinicians and even radiologists are not familiar with it. CMAC can be mistaken for an intra-cardiac tumour, thombus, vegetation, or abscess. Non-invasive multimodality imaging (i.e. Echo, MRI, and CT) helps to establish a definitive diagnosis of CMAC and avoid unnecessary interventions especially in uncertain cases.
干酪性二尖瓣环钙化（CMAC）是二尖瓣环钙化（MAC）的一种罕见液化变体，表面上模仿心脏赘生物或脓肿。CMAC 被视为 MAC 的良性病变，而 MAC 对患者的生命有临床意义。正确诊断 CMAC 对于避免不必要的干预、心脏手术甚至对患者的心理痛苦至关重要。
我们报告了 6 例疑似二尖瓣环内心脏肿块的患者，这些患者被转介到我们的机构以进一步澄清。通过对这些患者进行超声心动图（Echo）、心脏磁共振成像（MRI）和心脏计算机断层扫描（CT）的联合检查，明确了 CMAC 的诊断。Echo 评估了肿块本身以及与二尖瓣的可能相互作用。MRI 有助于将该组织与其他良性或恶性肿瘤区分开来。CT 显示了 CMAC 的典型结构，具有“柔软”液化中心和钙化的外壳。
CMAC 是一种罕见的疾病，大多数临床医生甚至放射科医生都不熟悉它。CMAC 可能被误诊为心脏内肿瘤、血栓、赘生物或脓肿。非侵入性多模态成像（即 Echo、MRI 和 CT）有助于明确诊断 CMAC，并避免在不确定的情况下进行不必要的干预。
