Caceres’ Corner: Case No. 35 (Update: Solution)

Dear friends,

Since some of you have been complaining about the cases being difficult, Muppet wants to show a really difficult case: a 76-year-old woman with previous heart troubles and currently asymptomatic.


1. Calcified pericardial cyst
2. Hydatid cyst of the heart
3. Intracardiac calcified aneurysm
4. None of the above

76-year-old- woman, PA chest

76-year-old- woman, lateral chest

76-year-old- woman, axial CT

76-year-old- woman, coronal CT

76-year-old- woman, sagittal CT

Click here for the answer to case #35

Be Sociable, Share!
    Sep 2012
    DISCUSSION 17 Comments

    17 Responses to : Caceres’ Corner: Case No. 35 (Update: Solution)

    1. Albert says:

      I would think of posterobasal left ventricular pseudoaneurysm. Probably due to a previous infarct.


      Caseous calcification of the mitral annulus

    3. Albert says:

      I also thought in the liquefactive necrosis of the mitral annulus because of the location and this calcic deposition (which seems to be characteristic); but the fact is that there is an addition imagen contrast filled which should be by definition a pseudoaneurysm. To be honest I dont’t know if this entity can complicate weakening the cardiac wall and cause secondarily a pseudoaneurysm.

    4. Genchi bari Italia says:

      Se la diagnosi è difficile , entra in campo il…BARI:a me sembra che la calcificazione, in sede ventricolare sx, abbia un peduncolo di raccordo con la mitrale e che la sua morfologia imita un muscolo papillare, ipertrofico e calcificato(fibro-elastoma m. papillare?), con cardiopatia congestizia da insufficienza cuore sx.

    5. Alice says:

      I would like to compare the Chest xr with older images, and check the clinical information for more details (has the patient had an infarction)?
      However, so far i favor the above mentioned caseous necrosis of calcified mitral annulus.

    6. Ricardo Macareno says:

      Cardiac hydatid cyst is not because the radiological findings are not typical and their frequency is very low (and even in that location even more heart).
      Nor calcified pericardial cyst that is not its most common and radiological findings are not typical.
      My question is 3 or 4. Still think ..

    7. dr.mike says:

      it’s a calcified aneurismal left pitvar ! so number 3 !

    8. Jess says:

      Dense calcification of the mitral valve makes me strongly consider Rheumatic Heart Disease in this elderly female…

      massive calcification of an atrial appendage/atrium (so-called ‘porcelain’ atrium is described

      Hence, my best bet in this patient with longstanding calcification of her mitral valve and left atrial appendage – rheumatic heart disease.

      Hence, answer is 4 = none of the above.

      Hey Dr Pepe and Dr Caceras,

    9. Jess says:

      any advice on how long one should take answering each structured questions in the actual EDIR exam? Some tips would be useful!

    10. Amaranducai Daniela says:

      3. Intracardiac calcified aneurysm

    11. Lola la Piconera says:

      My answer is 4.
      There is a wide left atrial calcification which suggests chronic mitral valve disease, may be rheumatic.Actually, there seems to be a valve calcification that affects not noly the annulus.

    12. vishal kalia says:

      The PA and lateral view of the chest x-ray shows curvilinear area of calcification in the region of anatomical landmark for ventricles(seen overlapping the cardiac shadow posteroinferiorly in lateral view and left retrocardiac region in PA view-suggesting ventricular region). CXR also shows evidence of cardiomegaly with dilated right branch of pulmonary artery. No evidence of any pleural effusion is seen. Single chamber pacemaker is seen in situ with its lead in right ventricle.
      Contrast enhanced CT shows a large lesion with thick walls in relation to the left atrioventricular groove. There is differential hyperdense attenuation within this lesion-possibly central part is contrast filled with outer calcified rim-suggesting pseudoaneurysm (true aneurysms are very rare at this location). there is small nipple like projection from its medial wall seen in coronal images-suggesting neck of pseudoaneurysm or communication with the coronary artery.Left atrium is separately seen. Rest of the visualised chambers appear normal. based on the imaging findings the possibility of intracardiac pseudoaneurysm appears likely(true aneurysms-as rare at ths site, wide neck and thin walled) arising from 1.coronary artery(in view of nipple like projection) or 2. from posteroinferior wall of left ventricle.

    13. olga says:

      Most likely left ventricular pseudoaneurysm

    14. Genchi Bari Italia says:

      Molte grazie per il bellissimo caso, molto istruttivo:adesso so tutto su BIB-MAC |