Reduced size of liquefaction necrosis of mitral annular calcification in chronic renal failure by using low calcium concentration hemodialysis.
A report is presented of a liquefaction necrosis of mitral annular calcification in a patient with chronic renal failure and secondary hyperparathyroidism who had been managed by hemodialysis for 11 years. The mass was echogenic with an echo-lucent area inside, high density on computed tomography and low intensity on magnetic resonance imaging. The uptake of gallium-67 (67Ga)-citrate and the bone agent technetium-99m-methylene diphosphate (99mTc-MDP) was seen in the mass. These findings were compatible with liquefaction necrosis of the mitral annular calcification. After treatment with low calcium concentration hemodialysis, the size of the mass reduced with disappearance of the echo-lucent area on the echocardiography and there was no uptake of 67Ga-citrate or 99mTc-MDP. Liquefaction necrosis might be the early and reversible form of mitral annular calcification. When a tumorlike echogenic mass at the base of mitral leaflets is seen in patients with predisposing factors for mitral annular calcification, consider the possibility of this specific form of mitral annular calcification in order to avoid any unnecessary surgical intervention.
Second Department of Internal Medicine, Cardiovascular Center, Kansai Medical University, Moriguchi, Japan. koitoh@takii.kmu.ac.jp
H
H
Koito
C
C
Nakamura
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J
Suzuki
H
H
Takahashi
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T
Iwasaka
D002114:Calcinosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D002118:Calcium; D002951:Citrates; D004452:Echocardiography; D005260:Female; D005708:Gallium; D005710:Gallium Radioisotopes; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology; D009336:Necrosis; D019275:Radiopharmaceuticals; D006435:Renal Dialysis / Q000009:adverse effects; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D002951:Citrates; D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals; D005708:Gallium; C103850:gallium citrate; D002118:Calcium; D013669:Technetium Tc 99m Medronate