Wavering calcified amorphous tumour of the heart in a haemodialysis patient

Cardiac calcified amorphous tumour: an unusual aetiology for recurrent cardioembolic strokes

We report an elderly woman with vascular risk factors and recurrent cardioembolic strokes in whom the stroke aetiology was finally ascertained to be a calcified amorphous tumour of the heart after repeated negative investigations for embolic aetiology over 2 years. This report discusses the clinical and imaging characteristics of calcified amorphous tumours of the heart with emphasis of recent advances in cardiac imaging.

Multiple cerebral infarctions due to calcified amorphous tumor growing rapidly from an antecedent infection and decreasing rapidly by detachment of fibrin and antithrombotic drugs: a case report

BACKGROUND

Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, a calcium deposition surrounded by amorphous fibrous tissue, and possibly causes cerebral embolism. Even rarer is CAT associated with infection, and no CAT with antecedent infection has been reported to our knowledge. In addition, although some CAT in patients on hemodialysis has been reported to grow rapidly, no case has been reported on CAT that grew and diminished rapidly in a short period of time. Here, we report the case of an 82-year-old Japanese woman with normal renal function who developed multiple cerebral infarctions due to CAT that grew rapidly, associated with inflammation from an antecedent infection, and diminished rapidly by detachment of fibrin on the mass surface and antithrombotic drugs.

CASE PRESENTATION

The patient developed fever after dental treatment and found musical hallucination on the left ear worsened in degree and frequency. In a nearby clinic, she was treated with antibiotics, and her body temperature turned to normal in approximately 1 month. She presented to our hospital for workup on the worsened musical hallucination. Magnetic resonance imaging (MRI) showed multiple cerebral infarctions, and transthoracic echocardiography (TTE) revealed an immobile hyperechoic mass with an acoustic shadow arising from a posterior cusp of the mitral valve. CAT was suspected and treated with apixaban and aspirin. Follow-up MRI and TTE showed newly developed multiple cerebral infarctions and rapidly diminished CAT. Cardiac surgery was performed to resect the CAT. The pathological findings showed calcifications surrounded by amorphous fibrous tissue including fibrin, indicating CAT. The patient's symptoms improved and no cerebral infarctions recurred in 4 months follow-up.

CONCLUSION

Inflammation from an antecedent infection can cause CAT to grow rapidly. Fibrous tissue including fibrin may attach to the surface of CAT, resulting in multiple cerebral infarctions. Fibrous tissue may detach and disappear by antithrombotic drugs, leading to a rapid diminishment of CAT in size.

Calcified amorphous tumor located on a severely calcified mitral annulus in a patient with normal renal function

A calcified amorphous tumor (CAT) of the heart is a rare, nonneoplastic, intracavitary cardiac mass. Histological examination shows that it contains calcified and amorphous fibrous material with underlying chronic inflammation. Surgical excision is generally recommended to avoid future embolism. The risk of embolism has been reported to be especially high in mitral-annular-calcification-related CAT, which constitutes a subgroup of CAT that is often associated with end-stage renal disease. A case of a CAT attached to the anterior annulus of the mitral valve that was easily removed with a light touch of the forceps through aortotomy is reported.

Calcified Amorphous Tumor of Left Ventricle: A Rare Cardiac Tumor

Cardiac calcified amorphous tumor (CAT) is a rare, non-neoplastic, intra-cavity cardiac mass. Only a few cases have been described in the literature.

A 46-year-old Indian female presented with decompensated heart failure. On echocardiography, 1.9 x 1.7 cm pedunculated mobile mass in the left ventricle attached to the intraventricular septum was seen. On cardiac magnetic resonance imaging (MRI), the lesion was isointense. Histopathology of the excised mass revealed fibrin deposition with eosinophilic amorphous material in the center with the periphery of the lesion showing calcification without any myxomatous tissue. A final diagnosis of CAT of the heart was established.

CAT is composed of calcium deposits in the background of amorphous degenerating fibrinous material. It presents as a pedunculated mass in any chamber of the heart with a very high preponderance of distal embolization. Differentiation from calcified atrial myxoma, calcified thrombi, or other cardiac neoplasms is very difficult. Histopathological examination is the mainstay of diagnosis. Treatment is emergency excision to prevent distal embolization.

CAT is a rare non-neoplastic tumor, which is mainly a tissue diagnosis after its resection.

A rapidly growing cardiac calcified amorphous tumour diagnosed after coronary artery bypass graft surgery: a case report

Background

A cardiac calcified amorphous tumour (CAT) is a non-neoplastic intracavitary cardiac mass. The most serious complication is systemic embolism. Cardiac CATs tend to be surgically resected immediately after detection; therefore, its progress of growth is rarely reported.

Case summary

An 83-year-old Japanese woman received on-pump beating coronary artery bypass graft surgery (CABG) for angina pectoris. Transthoracic echocardiography (TTE) performed preoperatively and 1 month postoperatively revealed the presence of mitral annular calcification, with no other abnormal findings. However, follow-up TTE performed 5 months after CABG revealed a mobile nodular mass (5.0 × 8.2 mm) in the left ventricular outflow tract. At 1 month after detection, the mass had enlarged to 5.0 × 13.0 mm. Transoesophageal echocardiography revealed that the pedunculated high-echoic mass was adhered to the posterior commissure of the mitral valve and was dynamically swinging towards the non-coronary cusp in the systolic phase. As the mass had grown rapidly in less than 6 months, it was surgically resected to prevent systemic embolism. The histological specimen consisted mainly of fibrin, including calcification and hemosiderin deposition, which lead to a diagnosis of cardiac CAT. The patient had an uneventful postoperative course during her hospital stay and had no evidence of recurrence for 1 year after discharge.

Discussion

This was a rare case in which a rapidly growing cardiac CAT was detected following on-pump CABG. Cardiac CATs may grow very rapidly and therefore early surgery should be considered after initial diagnosis.

The “MAC” Attack: When Mitral Annular Calcification Goes Rogue! A Case Series of Mobile Mitral Annular Calcifications

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CAT is a rare non-neoplastic tumor which may be associated with mobile MAC.

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Mobile component carries a high risk of embolization demonstrated in our case series.

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Calcified thrombus and CAT may be on a spectrum ranging from acute to chronic.

The First Report of Calcified Amorphous Tumor Associated with Infective Endocarditis: A Case Report and Review of Literature

BACKGROUND Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracardiac mass, which is composed of calcium deposition surrounded by amorphous fibrous tissue. The clinical presentation of cardiac CAT resembles that of other cardiac tumors or vegetation, though there is no previous report of a CAT complicated with infective endocarditis. CASE REPORT A 67-year-old male with a history of end stage renal failure and gastric cancer who was on adjuvant chemotherapy presented with a cardiac mass. The mass was resected and diagnosed as CAT pathologically. Two separate sets of blood cultures were positive for Enterococcus faecalis, thus, the patient was diagnosed with infective endocarditis. Antibiotic treatment was continued for 6 weeks after surgery, and the patient recovered uneventfully. However, he died from a complication of his gastric cancer 5 months later. CONCLUSIONS This is the first report of CAT associated with infective endocarditis. Blood cultures should be obtained to differentiate infective endocarditis or CAT with infectious endocarditis from CAT alone, because CAT with infective endocarditis may present atypically and may be more likely to require antibiotic treatment along with surgery.

Cardiac calcified amorphous tumour associated with multiple myeloma

We report an 86-year-old woman who was diagnosed with multiple myeloma (MM) and was receiving chemotherapy since the age of 82. A high echoic mass attached to the mitral valve was observed on transthoracic echocardiography 4 years after the treatment. The possibility of malignancy could not be ruled out, and hence, the mass was excised surgically. Pathologically, most of the mass consisted of calcified lesion without tumour tissue, and these findings were not inconsistent with calcified amorphous tumour (CAT). This case suggests that CAT may be associated with MM and has been reported after a thorough literature review.

A Rare Beast: Cardiac Calcified Amorphous Tumor

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CAT is a non-neoplastic intracardiac mass of uncertain etiology.

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Cardiac CAT has been found in various locations in the heart.

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Most cases are treated surgically, but conservative management may be preferred.

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Echocardiography plays a central role in the diagnosis and follow-up of cardiac CAT.

A Calcified Amorphous Tumor Originating in the Aortic Valve Cusp

Calcified amorphous tumor (CAT) of the heart is a rare nonneoplastic cardiac tumor. The clinical features of cardiac CATs resemble those of other cardiac tumors that include symptoms related to obstruction or embolization. Cardiac CATs have been found in all chambers of the heart but predominantly present in the left ventricle, mitral annulus, and mitral valve. Here we report an extremely rare case of CAT originating in the aortic valve cusp, which may be related to aortic annular calcification and aortic valve stenosis. We successfully treated this patient with tumor resection and aortic valve replacement.

Calcified Amorphous Tumor-Induced Acute Cerebral Infarction

We report the case of a 38-year-old woman who was admitted for acute cerebral infarction linked to a cardiac calcified amorphous tumor (CAT) and related mitral annular calcification (MAC). The cardiac mass was removed, and mitral valve replacement surgery was performed. Pathological examination revealed an amorphous accumulation of degenerating material within both lesions, indicating that build-up of calcium along the mitral annulus and subsequent rupture of the fibrotic tissue may be involved in the initiation and progression of CAT.

A Case of Cardiac Calcified Amorphous Tumor Presenting with Concomitant ST-Elevation Myocardial Infarction and Occipital Stroke and a Brief Review of the Literature

Cardiac calcified amorphous tumor (CAT) is an extremely rare benign intracavitary tumor of the heart. It may mimic other cardiac tumors and can present with signs or symptoms of systemic embolization. There are limited data regarding CAT in the literature. We report a case of a 68-year-old woman with a cardiac CAT and mitral annular calcification (MAC), who presented with acute ST-elevation myocardial infarction (STEMI) and occipital stroke. After extensive review of the literature, we believe that this case is possibly the first description of a cardiac CAT presenting with STEMI. The CAT was surgically removed, and the diagnosis was confirmed by histology. The patient tolerated the surgery and reported no events at 6-month follow-up.

Cardiac Calcified Amorphous Tumors in a Patient with Hemodialysis for Diabetic Nephropathy

Calcified amorphous tumor (CAT) is a rare, non-neoplastic tumor involving calcium deposition in amorphous materials. Although its etiology is unknown, cases have frequently been reported in patients with hemodialysis for chronic kidney disease. We herein describe a case of cardiac CAT in a 64-year-old woman who had been on hemodialysis for diabetic nephropathy for 20 years, and the findings of the present patient, in association with the findings of previous case reports, suggest that end-stage renal disease seems to play an important role in the onset of CAT, especially in CAT formation at the mitral annulus, which appears to differ from CAT occurring at other sites.

Calcified amorphous tumor of the heart with mitral annular calcification: a case report

Background

Calcified amorphous tumor of the heart is a rare, non-neoplastic cardiac mass characterized by nodular calcium in the background of amorphous degenerating fibrinous material. Clinical diagnosis of calcified amorphous tumor can be difficult, and current single imaging techniques do not specifically differentiate calcified amorphous tumor from other cardiac tumors such as calcified atrial myxoma, calcified thrombi, or vegetation. Complete surgical resection is the treatment of choice for both symptom improvement and prevention of embolization, as well as for pathological diagnosis.

Case presentation

A 70-year-old Asian man with end-stage renal disease complained of chest discomfort during exercise. He had no history of thromboembolism or endocarditis. A transthoracic echocardiogram revealed mitral annular calcification as well as a highly mobile mass (8 × 6 mm) attached to the ventricular side of the posterior mitral valve leaflet. As the mass was highly mobile, suggesting a high risk of embolization, he underwent surgical resection. A histopathological examination revealed multiple nodular amorphous calcifications, along with fibrous connective tissue. There were no identifiable myxoma or malignancy cells. Consequently, the diagnosis of calcified amorphous tumor was confirmed.

Conclusions

In the present case, a calcified amorphous tumor arose from mitral annular calcification. A characteristic of mitral annular calcification-related calcified amorphous tumor is its highly mobile nature, with a high risk of stroke or other systemic embolism. Therefore, surgical therapy should be considered for treatment of calcified amorphous tumors.

Cardiac calcified amorphous tumors: CT and MRI findings

PURPOSE

We aimed to evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cardiac calcified amorphous tumors (CATs).

METHODS

CT and MRI findings of cardiac CATs in 12 patients were included. We retrospectively examined patient demographics, location, size, shape configuration, imaging features, calcification distribution of tumors, and accompanying medical problems.

RESULTS

There was a female predominance (75%), with a mean age at presentation of 65 years. Patients were mostly asymptomatic on presentation (58.3%). The left ventricle of the heart was mostly involved (91%). CT findings of CATs were classified as partial calcification with a hypodense mass in four patients or a diffuse calcified form in eight. Calcification was predominant with large foci appearance as in partially calcified masses. On T1- and T2-weighted magnetic resonance images, CATs appeared hypointense and showed no contrast enhancement.

CONCLUSION

The shape and configuration of cardiac CATs are variable with a narrow spectrum of CT and MRI findings, but large foci in a partially calcified mass or diffuse calcification of a mass on CT is very important in the diagnosis of cardiac CATs. Masses show a low signal intensity on T1- and T2-weighted images with no contrast enhancement on MRI.

Calcified Amorphous Tumor Causing Shower Embolism to the Brain: A Case Report with Serial Echocardiographic and Neuroradiologic Images and a Review of the Literature

An 89-year-old woman with chronic atrial fibrillation, hypertension, chronic heart failure, and dementia was admitted to our hospital due to multiple small cerebral and cerebellar infarctions. Transthoracic echocardiogram revealed a floating calcified mass lesion arising from the endocardium of the posterior portion of the mitral annulus with mitral annular calcification. Furthermore, the mass had a heterogeneity of the echogenicity. The mass was diagnosed as a calcified amorphous tumor based on specific echocardiographic features. Serial echocardiograms showed shrinkage and disappearance of the mass, and magnetic resonance image revealed new infarction in the left occipital lobe. Embolization of the mass appeared to cause systemic embolism.

Cardiac Calcified Amorphous Tumor of the Mitral Valve Presenting as Transient Ischemic Attack

Cardiac calcified amorphous tumors (CATs) are an extremely rare nonneoplastic intracardiac masses. They have been reported in the literature in only a few cases. Thus, the incidence, pathogenesis, and best approach to the treatment are not certain. We report a case of CATs on the atrial surface of the anterior mitral valve leaflet in a 37-year-old female who was diagnosed by histopathological examination after surgical removal.

Swinging Calcified Amorphous Tumors With Related Mitral Annular Calcification

Among cardiac calcified amorphous tumors, the mitral annular calcification-related calcified amorphous tumor is extremely rare. We herein describe 3 surgical cases of swinging calcified amorphous tumor with related mitral annular calcification. The clinical, echocardiographic, and pathophysiologic features are reported here together with a brief review of the literature.

Surgical treatment of a calcified, amorphous tumor of the right ventricle complicated with thrombosis of the right pulmonary artery in an adult male: a case report

BACKGROUND

A calcified amorphous tumor of the heart is an extremely rare cardiac mass.

CASE PRESENTATION

A 32-year-old Albanian man presented to our hospital with fatigue, shortness of breath, progressive dyspnea, and right congestive heart failure. Echocardiography and chest computed tomography revealed a giant, calcified right ventricular mass that originated between the papillary muscles and the trabeculae and extended to the pulmonary valve. The patient underwent surgery with excision of the mass, replacement of the pulmonary valve with a biological one, and repair of the tricuspid valve. His histopathological examination revealed that the mass was a calcified, amorphous tumor. His postoperative course was uneventful.

CONCLUSIONS

The clinical presentation of the calcified amorphous tumor is similar to that of other cardiac tumors, so surgical excision is mandatory. Histopathological examination remains the gold standard for an accurate diagnosis.

Surgical removal of calcified amorphous tumor localized to mitral valve leaflet without mitral annular calcification

A cardiac calcified amorphous tumor (CAT) localized to the mitral valve leaflet without mitral annular calcification (MAC) is a rare entity. We report a case of a 69-year-old woman with such a condition, who underwent successful excision of the tumor and mitral valvuloplasty using a glutaraldehyde-treated autologous pericardium. During 38 months of follow-up, no recurrence of a cardiac mass has been recognized. This report addresses questions on the surgical indication for CAT, particularly in cases without MAC, and reviews CATs of the mitral valve.

Cardiac calcified amorphous tumor in a hemodialysis patient

We present a case of cardiac calcified amorphous tumor, a rare intracardiac non-neoplastic tumor, in a hemodialysis patient. A 72-year-old woman with no history of thromboembolic, malignant, or inflammatory disease presented with dyspnea. Echocardiography revealed a highly echoic, slightly mobile mass with an acoustic shadow originating from the mitral subvalvular apparatus, extending to the left ventricular outflow tract. She underwent surgical resection of the mass through the aortic valve, which was easily excised from the papillary muscle and chordae tendineae. Histopathologic examination revealed nodular calcium deposits on a background of amorphous degenerated fibrin material, consistent with calcified amorphous tumor.

Cardiac calcified amorphous tumor: A systematic review of the literature

BACKGROUND

Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracavitary cardiac mass. Several case reports have been published but large series are lacking.

OBJECTIVE

To determine clinical features, current management and outcomes of this rare disease.

DESIGN

A systematic review of all articles reporting cases of CAT in order to perform a pooled analysis of its clinical features, management and outcomes.

DATA SOURCES

An electronic search of all English articles using PUBMED was performed. Further studies were identified by cross-referencing from relevant papers.

INCLUSION CRITERIA

We restricted inclusion to articles reporting cases of CAT in the English language literature published up to July 2014.

DATA EXTRACTION

One author performed data extraction using predefined data fields.

RESULTS

A total of 27 articles, reporting 42 cases of CAT were found and included in this review.

CONCLUSION

In this review, the most frequent presenting symptoms were dyspnea and embolic events. Mitral valve and annulus were the most frequent location of CAT. Surgery was most of the time required to confirm diagnosis, and was relatively safe. Overall outcome after surgical resection was good.

Swinging cardiac calcified amorphous tumour arising from a calcified mitral annulus in a patient with normal renal function

A 67-year-old man was referred to our institution for the management of a left-sided intracardiac mass discovered following two cardioembolic events. Imaging studies revealed a highly mobile mass attached to the ventricular side of a calcified mitral annulus. The mass had not been present on echocardiography 1 year earlier. Surgical resection was performed. Microscopic examination confirmed the diagnosis of a calcified amorphous tumour. The postoperative course was unremarkable, and the patient remains asymptomatic and without recurrence of a mass or neurological event after a 12-month follow-up.

Calcified amorphous tumor in the left atrium in a patient on long-term peritoneal dialysis

A 66-year-old woman with an 11-year history of peritoneal dialysis (PD) for diabetic nephropathy and renal failure exhibited a movable tumor in the left atrium on echocardiography. Tumor resection was performed due to the difficulty in diagnosing the tumor and the future risk of heart failure and embolization. Light microscopy showed a calcified amorphous tumor (CAT), a rare intracardiac mass characterized by the presence of a pedicle and diffuse calcification. An increased calcium-phosphate product level was suspected as an etiology, although degeneration, inflammation and/or mineral balance disorders may also induce the development of CAT. We herein report the first known case of CAT in a PD patient.

A case of cardiac calcified amorphous tumor (cardiac CAT) causing acute embolism in right common iliac artery

A 68-year-old man was admitted to our hospital for the further examination of intermittent claudication. He had been on continuous ambulatory peritoneal dialysis for 2 years. Screening transthoracic echocardiography (TTE) revealed a club-shaped tumor and a round-shaped tumor attached to mitral annulus calcification (MAC). The club-shaped tumor was swinging and plunged into the left ventricle at diastolic phase. Because of the risk of fatal embolism, we planned early surgical resection of the tumors. However, 13 days after admission, his intermittent claudication was getting worse and some part of the club-shaped tumor had vanished by TTE. Urgent iliac angiography showed that the tumor had embolized the right common iliac artery. Although we tried embolectomy using a Fogarty catheter, it was unsuccessful. We therefore treated the iliac artery stenosis by endovascular therapy and the procedure was successful. Three months later, he suffered from unstable angina and was treated by percutaneous coronary intervention. However, subacute stent thrombosis occurred after one month. After urgent treatment, we decided to treat him by coronary artery bypass graft and surgical resection of the residual tumor on MAC. The operation was performed successfully. Finally, the tumor was diagnosed as cardiac calcified amorphous tumor by its histologic features. <Learning objective: Cardiac calcified amorphous tumor (CAT) is a rare, non-neoplastic cardiac tumor. Mobile and pedunculated cardiac CAT is considered to be an important risk of systemic embolism. Based on our case and previous reports we reviewed cardiac CAT, especially MAC-related CAT, and it appears to be related to end-stage renal disease and may grow within a short duration. It is important to perform routine serial echocardiography for hemodialyzed patients in whom MAC has been identified.>.

Calcified amorphous tumor in left atrium presenting with cerebral infarction

Calcified amorphous tumor (CAT) of the heart is an extremely rare cardiac mass. We describe a case of cardiac CAT in a 70-year-old Korean female who presented with acute onset dysarthria and right side weakness. Echocardiography and chest computed tomography revealed a left atrial mass that originated from the interatrial septum. The patient underwent surgical resection and pathologic examination demonstrated CAT. Postoperative course was uneventful and she was followed without recurrence.

Calcified amorphous tumor of the left ventricular outflow tract

We report a very rare case of a calcified amorphous tumor presenting atypically as a mobile left ventricular outflow tract mass in a 69-year-old female who was admitted for shortness of breath.