UFO in the heart revealed during balloon mitralvalvuloplasty for severe mitral stenosisAjit Pal Singh Anshu Kabra Vivek Singla Thagachagere Ramegowda Raghu

Department of CardiologySri Jayadeva Institute ofCardiovascular Sciences andResearch BengaluruKarnataka India

Correspondence toDr Vivek Singladrviveksingla98gmailcom

To cite Singh AP Kabra ASingla V et al BMJ CaseReports Published online[please include Day MonthYear] doi101136bcr-2012-008166

DESCRIPTIONA 39-year-old man presented with worsening dys-pnoea on exertion of 1-year duration Cardiac aus-cultation revealed a loud first heart sound with asoft rumbling mid-diastolic murmur ECG showedP mitrale with tall R wave in V1 Chest roentgeno-gram revealed cardiomegaly with straightening ofthe left heart border suggestive of left atrial (LA)appendage enlargement dilation of the right andleft pulmonary arteries (horizontal arrows) andprominence of the both upper lobe pulmonaryveins A hyperdense lesion was noted in the leftborder of the cardiac silhouette (vertical arrowfigure 1) Transthoracic echocardiogram doneshowed severe mitral stenosis with a valve area of08 cm2 No massthrombus could be delineated ontransesophageal echocardiogram During the percu-taneous balloon mitral valvuloplasty procedure afree floating calcified mass was seen inside thecardiac silhouette (figure 2 video 1) Possibilitiesconsidered were LA appendage massthrombushealed vegetation mitral annulus calcification andpericardial calcification A 64 slice multidetectorCT carried out showed a 17times13 cm calcifiedlesion along the pericardium of the left ventricle(figure 3AndashC) Cardiac CT is an extremely useful

modality for delineation of pericardial calcifica-tion1 2 Various causes of pericardial calcificationinclude inflammatory diseases such as Tuberculosisprior pericarditis radiation uraemia hemopericar-dium connective tissue disorders and rheumaticfever Pericarditis related to previous attacks ofrheumatic fever was attributed as the possible causeof the calcification in this case

Figure 1 Chest roentgenogram showing cardiomegalystraightening of left heart border dilated pulmonaryarteries and a small hyperdense mass in the leftsilhouette

Figure 2 A calcified mass (the lsquoUFOrsquo) seen duringballoon mitral valvuloplasty

Video 1 Cine film showing mobile calcified massduring balloon dilatation of the mitral valve

Singh AP et al BMJ Case Reports 2013 doi101136bcr-2012-008166 1

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Learning points

Chest roentgenogram or fluoroscopy may not delineate thenaturelocation of pericardial mass

Pericardial calcification can occur as a benign entity as aresponse to previous inflammation

Aetiology of pericardial calcification includes inflammatorydiseases such as tuberculosis carditis radiation uraemiahemopericardium connective tissue disorders and rheumaticfever

Competing interests None

Patient consent Obtained

Provenance and peer review Not commissioned externally peer reviewed

REFERENCES1 Kibar Yared MD Aaron L Baggish MD et al Multimodality imaging of pericardial

diseases JACCCardiovasc Imag 20103650ndash602 Isner JM Carter BL Bankoff MS et al Computed tomography in the diagnosis of

pericardial heart disease Ann Intern Med 198297473ndash9

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Figure 3 (AndashC) Coronal sagittal and axial multidetector CT scan sections demonstrating the location of the calcified mass in the pericardium

2 Singh AP et al BMJ Case Reports 2013 doi101136bcr-2012-008166

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ownloaded from