Discussion
Primary cardiac tumour is rare and most common tumour is atrial Myxoma.
Calcified amorphous tumour (CAT) is a rare cardiac mass. This tumour is
more common in female than in male. Most of the affected patients are of
fifth decade.
Pathogenesis of the tumour is formation of thrombus due to
hypercoagulability and abnormal calcium and phosphorus metabolism.
Growth rate of calcified amorphous tumour is slow but growth rate of
calcified amorphous tumour associated with mitral annular calcification
is fast. Most common location is mitral annulus which is commonly due to
previous mitral annular calcification and it is commonly due to end
stage renal disease. Other affected chambers of the heart according to
incidence are right atrium, right ventricle, left ventricle, left atrium
and tricuspid annulus.[2]
Most common presenting symptom is dyspnea on exersion due to obstruction
of the blood flow. Other presenting features are angina, syncope (due to
distal embolism), pulmonary embolism, systemic embolism and rarely
patient may be diagnosed incidentally. Other associated diseases are
valvular heart disease ,end stage renal disease,
hyperparathyroidism.Chances of embolic events is more in calcified
amorphous tumour with mitral annular calcification.[3]
On echocardiography CAT is described as pedunculated calcified mass.
Size may vary from small puntate lesion to very large mass. Myxoma is
mobile mass and 20 % of atrial Myxoma are calcified. Cardiac fibroma is
calcified intra myocardial mass in which commonly left ventricle is
involved. Other cause of cardiac calcification are end stage renal
disease and thrombus.[4] On CT scan or MRI calcified amorphous
tumour are either irregular, ovoid, triangular, spherical or tubular. On
configuration mass is either polypoid or infiltrative with or without
broad base and distribution of calcification is partial or diffuse. On
cardiac MRI homogenous appearance with low signal intensity on T1 and T2
weighted spin echo sequences without post gadolinium contrast
enhancement in early and delayed sequences.[5]
Patients are treated with operative management. After midline sternotomy
aorto bicaval or aorto atrial cannulation is done according to the
chamber involved.Right atrial and right ventricular lesion are
approached through right atrium. Left atrial lesions are approached
through left atrium or right atrium.Left ventricular lesion are
approached through left atrium. Ventricular approach are not preferred
because of increased chance of ventricular tachycardia. On
histopathological examination deposition of heterogeneous calcium with
surrounding amorphous eosinophilic and fibrinous material is
found.[6] Immediate postoperative outcome is good with very less
chance of recurrence.[2]
Conclusion: Calcified amorphous tumour is rare tumour. Early
detection and management is needed to prevent complication. Recurrence
is rare. Since clinico-echocardiographical presentation is similar,
histopathological diagnosis is mandatory.