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

Case report: A primary calcified cardiac mass in right atrium partially obstructs the tricuspid valve in a patient on hemodialysis

Primary cardiac calcification is a rare benign mass in patients with end-stage renal disease. A few cases have been reported in the literatures. In this case study, during a routine checkup for hemodialysis, a transthoracic echocardiography on a 19-year-old male showed a cardiac mass in the right atrium that was partially obstructing the tricuspid valve. Cardiac magnetic resonance imaging showed a well-circumscribed, homogeneous “shadow” in the right atrium; it measured 29 × 27 mm, had equal T1- and T2-weighted signal intensities, and was adjacent to the tricuspid valve. According to 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography, there was a dense circular shadow in the right atrium abutting the tricuspid valve, but there was no increase in glucose metabolism. Median sternotomy was performed for the surgical resection of the mass, and a cardiopulmonary bypass was completed. The mass was completely removed. The patient recovered well and was discharged 10 days after the surgery. Histological examination showed that the mass contained multiple calcified nodules. No mass recurrence was found by echocardiography during the 12th-month follow-up.

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.

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.