Images in cardiovascular medicine. Calcified amorphous tumor of the heart

Cardiac calcified amorphous tumor as a potential cause of cerebral infarction: A clinical case report

We report the case of a 62-year-old male on long-term hemodialysis who was admitted to our hospital due to acute cerebral infarction associated with a cardiac calcified amorphous tumor (CAT). The patient presented with recurrent episodes of syncope and retrograde amnesia. Brain MRI identified multiple acute cerebral infarctions, while transthoracic echocardiography (TTE) revealed a 2.5 cm echogenic mobile mass attached to the ventricular side of the posterior mitral leaflet. The patient underwent surgical resection of the mass. Pathological examination confirmed the diagnosis of a CAT. A chest computed tomography (CT), performed incidentally for pneumonia 6 months prior, revealed extensive calcifications in the mass. Postinfarction imaging showed a reduction in calcifications within the mass, suggesting a potential link between the infarction and changes in the cardiac lesion.

Extracavitary Cardiac Calcific Amorphous Tumors Compressing Biventricular Outflow Tracts

Extracavitary cardiac calcific amorphous tumors/masses are extremely rare. We present a case report of a 62-year-old man with end-stage renal disease who presented with extracavitary cardiac calcific amorphous tumors/masses compressing the biventricular outflow tracts, resulting in hemodynamic compromise and progressive limitation of activities. The patient was successfully treated with surgery, with complete resolution of symptoms and markedly improved quality of life.

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.

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 Case of Cardiac Calcified Amorphous Tumor: Multi-Modality Imaging Evaluation

Patient: Male, 47

Final Diagnosis: Cardiac calcified amorphous tumor

Symptoms: Dizziness

Medication: —

Clinical Procedure: —

Specialty: Cardiac Procedure

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.

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.

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.

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 tumors (CATs) of the heart

Intracavitary cardiac masses include neoplastic and nonneoplastic masses, which may share overlapping clinical symptomatology, physical examination findings, and or imaging characteristics. Definitive diagnosis of a cardiac mass is usually made on surgical excision and histological examination. In this article, we focus on one of the rare nonneoplastic cardiac mass, namely, calcified amorphous tumors. We present a series of three patients, an 80-year-old female who presented to the hospital for evaluation of a near syncope event, a 69-year-old female who presented for evaluation of palpitations, and a 60-year-old female who presented for evaluation of shortness of breath, who were found to have calcified amorphous tumors. We have also provided a relevant review of the literature on this topic.

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.

Cardiac restriction secondary to massive calcific deposits in the left ventricular cavity

Described herein are clinical and necropsy findings in a 61-year-old woman with fatal left ventricular diastolic failure secondary to massive calcific deposits primarily within the left ventricular cavity. At age 3, an isthmic aortic coarctation was resected, and at age 44, a stenotic congenitally bicuspid aortic valve was replaced. The cause of the intracavitary calcific deposits remains unclear, but surgical resection of the deposits has been an effective form of therapy.

Cardiac calcified amorphous tumor stuck in the aortic valve that mimicked a chameleon's tongue: report of a case

A calcified amorphous tumor (CAT) is a rare intracardiac mass that carries a risk of embolism. We herein present the case of a club-shaped CAT that originated from the calcified mitral annulus. Echocardiography indicated a pendular motion of the mass and repeated entrapment by a stenotic aortic valve that was sustained for several beats, mimicking a chameleon's tongue. An emergency operation was performed because of the risk of embolism, as well as potential progression of cardiac failure due to worsening aortic valve stenosis. The histological findings were consistent with the diagnosis of a CAT. This report describes a case of an intracardiac tumor that showed unique motion like a chameleon's tongue.

Wavering calcified amorphous tumour of the heart in a haemodialysis patient

Calcified amorphous tumour is a rare, non-neoplastic, endocardially based, intracavitary cardiac mass. This report describes a 59-year old man in whom a mobile mass was found incidentally in the heart by routine echocardiography after he had been on haemodialysis for 3 years. Transoesophageal echocardiography revealed a high-echoic swinging tumour that originated from the annulus of the anterior commissure of the mitral valve. Surgical resection was performed to prevent embolization, and his clinical course was excellent.

Long-term follow-up of a rare calcified cardiac tumor: a case report

We describe a case of cardiac masses (high- and iso-echoic mass) which were detected by echocardiography in a 57-year-old man with cerebral infarction. Because he refused both biopsy and surgery, the patient was treated with an anticoagulant and antibiotic in our outpatient clinic. During 3-year follow-up, the iso-echoic mass disappeared and the high-echoic mass did not change. Thus, we considered the iso-echoic mass a thrombus and the high-echoic mass a benign tumor. Cardiac computed tomography revealed that the high-echoic mass had extensive calcifications like phleboliths, and magnetic resonance imaging pattern coincided with that of hemangiomas. We conclude that the benign tumor/high-echoic mass might be a vascular malformation.

Native Cardiac Valve Pathology

Anatomy of the native cardiac valves, reasons for surgical excision and examination, and a summary of the gross examination and documentation are presented. Aortic stenosis, aortic valve regurgitation, tricuspid and pulmonary valve pathology, mitral stenosis, and mitral insufficiency are each presented with an overview, focused anatomy, and discussion of pathologic diagnosis by gross examination and histology.

Unusual Presentation Chronic Pulmonary Embolism due to Calcified Right Ventricular Mass

Cardiac calcified amorphous tumors (CATs) can arise in all four chambers of the heart. Cardiac CATs can cause diverse symptoms according to their locations, and mass or embolic effects. Pulmonary emboli arising from cardiac CATs have been reported, but the true incidence is unknown due to their rarity. Herein we report a rare case with diffuse CATs in the right ventricle which caused a calcific pulmonary embolism and right-sided heart failure. Echocardiography, chest non-contrast computed tomography, and cardiac magnetic resonance imaging helped us diagnose the CATs. We recommend the usefulness of a multimodality imaging approach to characterize intracardiac masses and their complications accurately.

Calcified amorphous tumour of the heart: presentation of a rare case operated using minimal access cardiac surgery

Calcified amorphous tumour (CAT) of the heart is a rarely reported non-neoplastic cardiac mass. The authors report a 69-year-old female with long-standing severe asthma and on home oxygen, who presented with a 2 cm mobile mass in the left ventricular outflow tract and symptoms of left heart failure and stroke. During minimal access cardiac surgery, a CAT was found attached to the base of the mitral valve. The tumour was removed and the patient had an uneventful postoperative course. The authors present their experience with this patient and review the current literature on this rare kind of tumour.

Cardiac swinging calcified amorphous tumors in end-stage renal failure patients

We recently encountered 2 patients with mobile cardiac calcified amorphous tumors who were successfully treated by surgery. Both patients had mitral annular calcification and were on hemodialysis. These tumors showed swinging motion on echocardiography and they grew rapidly. Intraoperatively, the tumors were found to be fragile and they easily detached from their origin. The histologic findings were thrombus with angiogenesis, fibrin, and calcium deposition. This rapid-growing mobile tumor in end-stage renal failure patients is speculated to increase the risk of embolic events and should be included as a special entity of cardiac amorphous tumors.

Cardiac calcified amorphous tumor in a patient presenting for ventricular tachycardia ablation: intracardiac echocardiogram diagnosis and management

Calcified amorphous tumors (CAT) of the heart are rare primary cardiac tumors characterized by heavy myocardial and valve apparatus calcification. The relationship of the entity with ventricular arrhythmia, if any, is unknown. We describe a case of cardiac CAT in a 58-year-old woman with prior cardiac arrest and recurrent ventricular tachycardia who presented for radiofrequency ablation. Pre-ablation intracardiac echocardiogram revealed the characteristic endomyocardial calcific pattern associated with this tumor that precluded catheter manipulation in the left ventricle. The imaging characteristics and management are described.