LAUSR

© BMJ Publishing Group Limited 2023. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION The cardiac calcified amorphous tumour (CAT), which is originally described by Reynolds and colleagues, is a very rare nonneoplasmic cardiac mass. Since only few reports have been published, the cause, clinical manifestations and treatment of this tumour remain unknown. A previously healthy woman in her 80s presented to the ophthalmology clinic of our institution with a 2week history of acute painless vision loss in her left eye. Dilated fundus examination of her left eye revealed a visible motile embolus in the branch of the retinal artery bifurcation. A diagnosis of branch retinal artery occlusion was made. Ttransthoracic and transoesophageal echocardiography and CT angiography (figure 1A–C) demonstrated diffuse calcification affecting the mitral annulus and mitral leaflets and a pedunculated, mobile tumour that originated from the annulus of the posterior leaflet of the mitral valve. The primary and secondary tumours were hyperechoic and measured 19×5 mm and 5×2 mm, respectively. Mitral regurgitation was not detected, and the left ventricle systolic function was not depressed with a volumetric calculated ejection fraction of 65%. ECG revealed normal sinus rhythm and no arrhythmia. Laboratory data showed no evidence of an inflammatory reaction and renal dysfunction. To prevent any further embolic events, emergency surgery was performed. Considering her general condition, we decided to perform endoscopic tumour resection via right thoracotomy. After the left atrial incision, the mitral valve and tumours were clearly visualised by endoscopy (figure 1D,E and video 1). Although the mitral valve showed a little degenerative change, no evidence of infectious endocarditis was observed. Two soft and fragile tumours were easily removed by using forceps without exerting any force. This patient is alive and well with no evidence of tumour recurrence 6 months after the operation. Histologically, the lesions were similar and composed of nodular deposits or flecks of calcium within a background of eosinophilic, amorphous and sometimes fibrillar material (figure 2). Based on the pathological findings and the irregularly shaped calcific cardiac mass demonstrated by CT, the patient was diagnosed with a CAT of the heart. Cardiac CAT is a rare nonneoplastic cardiac mass that mimics malignancy and causes symptoms due to obstruction or embolisation of calcific