case_images: PMC6487139_01
case_images: Computed tomography ((a) multiplanar reformatted (MPR) and (b) maximal intensity projection (MIP)) demonstrated extensive infiltrative calcification, circumferentially around the mitral annulus, extending posteriorly and septally into the myocardial apex. RA: right atrium; RV: right ventricle; LA: left atrium; LV: left ventricle.
case_images: CRIC2019-6707690.001.jpg
case_images: PMC6487139_01_CRIC2019-6707690.001.jpg
case_images: fig1
case_images: MAC which infiltrated the left ventricular myocardium resulting in widespread intramyocardial calcification, predominantly in the septum and anterior wall and also in the apex and apical lateral wall (Figure 1). Maximal septal LV wall thickness measured 28 mm and similarly around the infiltrative lesions.
case_images: (a) Magnetic resonance T1-weighted spin echo demonstrating multiple low signal lesions throughout the left ventricular myocardium (*), consistent with extensive infiltrative calcification of the myocardium. (b) Magnetic resonance phase-sensitive inversion recovery late gadolinium enhancement demonstrating a heterogenous composition to the intramyocardial lesions within the nulled myocardium (^), suggestive of caseating calcification within the myocardium (four-chamber view Siemens Avanto 1.5 Tesla).
case_images: CRIC2019-6707690.002.jpg
case_images: PMC6487139_01_CRIC2019-6707690.002.jpg
case_images: fig2
case_images: Coronary angiography illustrating the absence of significant obstructive coronary artery disease and highlighting extensive myocardial calcification (*), particularly prominent around the mitral valve annulus: (a) left anterior oblique view and (b) right anterior oblique view. RCA: right coronary artery; LCx: left circumflex artery; LAD: left anterior descending artery.
case_images: CRIC2019-6707690.003.jpg
case_images: PMC6487139_01_CRIC2019-6707690.003.jpg
case_images: fig3