title: An 82-year-old woman with a cardiac mass.
abstract: An 82-year-old woman suspected of a cardiac tumour was referred for evaluation. Patient's medical history included atrial fibrillation, implantation of a VVI (ventricular stimulation) pacemaker 3 years earlier due to advanced atrioventicular (AV) block, arterial hypertension and hypothyroidism. Patient was adequately anticoagulated with warfarin (international normalized ratio (INR) 3.0 at admission). She reported occasional palpitations and a 2 kg weight loss in the last 2 years, but denied shortness of breath, chest pain, malaise, fever, chills or cough. Blood samples were taken for tests and cultures. Red blood cells, haemoglobin, white blood cells, platelets, C- reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were within normal ranges. Blood cultures were negative. Echocardiogram (figure 1A) (see online supplementary videos 1 and 2) and cardiac CT were performed (figure 1B).
  
  
  
  Which of the following is the most likely diagnosis?Caseous calcification of the mitral annulusCoconut left atriumMitral valve myxomaPeriannular abscess.
authors.affiliation: Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Galas
authors.affiliation: Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Hryniewiecki
authors.affiliation: Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Szymanski
mesh_terms: D000369:Aged, 80 and over; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000628:therapy; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed