J Thorac Cardiovasc Surg 2006;131:738-739
© 2006 The American Association for Thoracic Surgery
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
Received for publication November 2, 2005; accepted for publication November 16, 2005. * Address for reprints: Lawrence H. Cohn, MD, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Email: Lcohn@partners.org).
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Mitral annular calcification (MAC) is common in the elderly population. It can cause mitral regurgitation, mitral stenosis, and heart block and can complicate attempts to repair or replace the mitral valve. Extensive MAC can undergo liquefaction and simulate an intracardiac mass. Previously this rare entity was believed to be a benign incidental finding on imaging. We describe a case of caseous MAC mimicking a cardiac tumor and causing spontaneous cerebral embolization.
A 79-year-old woman was referred to our institution after experiencing painless monocular vision loss. Examination was consistent with central retinal artery embolism. Magnetic resonance imaging revealed bilateral microvascular infarctions in the anterior circulation. Transthoracic echocardiogram and a gated chest computed tomogram (Figure 1, A) showed a 3-cm heavily calcified mass associated with the posterior mitral annulus. Her presentation was initially believed to be most consistent with embolization from intracardiac tumor.
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