Purposeful use of multimodality imaging in the diagnosis of caseous mitral annular calcification: a case series report.

BACKGROUND: Caseous mitral annular calcification (CMAC) is a rare liquefactive variant of mitral annular calcification (MAC) and superficially mimics a cardiac vegetation or abscess. CMAC is viewed as a benign condition of MAC, while MAC has clinical implications for patients' lives. Correctly diagnosing CMAC is essential in order to avoid unnecessary interventions, cardiac surgery or even psychological suffering for the patient. CASE PRESENTATION: We report on 6 patients with suspected intra-cardiac masses of the mitral annulus that were referred to our institution for further clarification. A definitive diagnosis of CMAC was achieved by combining echocardiography (Echo), cardiac magnetic resonance imaging (MRI) and cardiac computed tomography (CT) for these patients. Echo assessed the mass itself and possible interactions with the mitral valve. MRI was useful in differentiating the tissue from other benign or malign neoplasms. CT revealed the typical structure of CMAC with a "soft" liquefied centre and an outer capsule with calcification. CONCLUSION: CMAC is a rare condition, and most clinicians and even radiologists are not familiar with it. CMAC can be mistaken for an intra-cardiac tumour, thombus, vegetation, or abscess. Non-invasive multimodality imaging (i.e. Echo, MRI, and CT) helps to establish a definitive diagnosis of CMAC and avoid unnecessary interventions especially in uncertain cases.

An unusual cause of anterior wall ST-elevation myocardial infarction: a case report.

Background: Metastatic tumours, notably lung cancer, can cause conditions resembling acute myocardial infarctions (AMIs), contributing to the minor percentage of AMIs unrelated to coronary atherosclerosis. These instances necessitate specialized diagnostic and therapeutic approaches due to the distinct underlying pathology. Case summary: We report a case of a 65-year-old male with metastatic lung cancer presenting with prolonged angina pectoris. Elevated troponin and creatine kinase levels led to emergency catheterization, revealing a total occlusion of the distal left coronary artery attributed to tumour infiltration. Intervention attempts were unsuccessful, and given the palliative context, other revascularization strategies were not pursued. Two-dimensional transthoracic echocardiogram depicted tumour invasion at the heart's apex, confirming the diagnosis. The patient passed away shortly after receiving palliative radiation therapy. Discussion: This case underscores the challenges in diagnosing and managing myocardial infiltrations from metastatic tumours mimicking AMI. It accentuates the importance of imaging studies for accurate diagnosis and the critical evaluation of intervention strategies, highlighting the need for focused palliative care in such complex scenarios.

Quantitative analysis of regional lung ventilation and perfusion PET with (68)Ga-labelled tracers.

INTRODUCTION: The aims of this study were to determine the quantitative parameters of ventilation (V) and perfusion (Q) PET scans assessing V/Q quotients in patients with various lung pathologies, as well as the influence of patient position on regional perfusion patterns. METHODS: Fifty-three patients (24 male and 29 female) underwent lung scintigraphy with (68)Ga-labelled radiopharmaceuticals. (68)Ga Galligas and B20 microspheres used for V and Q imaging were produced in-house. Images were acquired under a standard setup with two emission scans of the whole lung in the supine (S) position (acquisition time 3 min/bed position) on a PET/CT scanner combined with low-dose computed tomography (CT) for attenuation correction. In 27 patients the Q scan was repeated in the prone (P) position. Parametric images were calculated (V/Q, P/S when applicable) for each patient. Patients were grouped according to diagnostic findings, and V/Q ratio distributions were further analysed. Gradients of the regional blood flow in both the supine and prone position were calculated. RESULTS: The results from visual interpretation could be confirmed with parametric images. Voxel-wise V/Q analysis revealed significant differences in descriptive parameters such as median, mean and SD between normal patients and patients with acute and previous pulmonary embolism. Skewness and kurtosis were not significantly different. The effect of gravitation could be demonstrated by significant position-dependent changes of the gradients in the ventral-dorsal and apical-basal directions. CONCLUSION: PET/CT using (68)Ga-labelled tracers allows the application of quantitative procedures to improve functional pulmonary imaging in clinical diagnosis and research.