The end of the season is near and I want to show easy cases. Radiographs belong to a 78-year-old woman with dyspnoea. What do you see?
Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.
Findings: chest radiographs show an enlarged heart with a pacemaker. The intriguing finding is a rounded cardiac calcification barely seen in the PA view (A, arrow), and more obvious in the lateral projection (B, arrow). The curvilinear appearance may suggest a calcified aneurysm to the non-initiated, whereas in fact it represents a caseous necrosis of the mitral annulus due to liquefaction of the annulus. It is an uncommon variant of the more frequent C-shaped appearance.
The findings on the plain film are confirmed with the typical appearance in CT (C-D, arrows).
I am showing radiographs of another case seen a few weeks ago, which could be appropriately named as “the mother of all necrosis” (E-F, arrows).
Final diagnosis: caseous necrosis of the mitral annulus
Congratulations to MK, who suggested the diagnosis
Teaching point: know the normal variants. Will prevent you from making erroneous diagnosis and taking unnecessary examinations
Hello,
There is round nodule projecting over vertebra with asymetric enlargement of right hilum. I suppose lung npl with metastatic lymph nodes to hilum.
Unicameral pacemaker and electrodos.
There is an increased pulmonary trunk and a big right hilum perhaphs because of pulmonary hypertension. Calcified aortic knob.
In the left vetricle there is a high density contour perhaphs because of an aneurysm.
The hight density in the left ventricle would be a caseous necrosis of the mitral annulus, and less probably calcifications in the fibrous annulus of the mitral valve (not C form)
….molto caro PROF……la punta del catetere-elettrodo , anziché’ in ventricolo dx, lo ha oltrepassato….inoltre una calcificazione , grossolana ed irregolare a carico del ventricolo sx,è’ l’esito di un aneurisma calcificato, post-infartuale……vittoria meritatissima del Real….non credevo fosse così’ forte…..un gioco tutto il contrario del kiti-taka del Barca…poche geometrie e subito in rete….
Dear friend, although your judgment of Barça is correct, your diagnosis isn’t.
See the answer tomorrow. Enjoy your vacation!
….molto caro PROF……la punta del catetere-elettrodo , anziché’ in ventricolo dx, lo ha oltrepassato….inoltre una calcificazione , grossolana ed irregolare a carico del ventricolo sx,è’ l’esito di un aneurisma calcificato, post-infartuale……vittoria meritatissima del Real….non credevo fosse così’ forte…..un gioco tutto il contrario del kiti-taka del Barca…poche geometrie e subito in rete….