Aortic arch anomaly in an adult patient: a case of right aortic arch with aberrant left subclavian artery and Kommerell's diverticulum

Radiol Bras. 2016 Jul/Ago;49(4):267–276 274 In most cases are asymptomatic patients, and the diagnosis is established by examination of cardiac imaging performed for other purposes. The symptoms, when present, correspond to palpitations, dyspnea, and syncope. The prognosis of caseous degeneration of the mitral annulus is good, especially in patients who are asymptomatic, although some patients develop severe symptomatic valvular dysfunction; in the latter group of patients, the prognosis is poor and surgery should be considered. On the CCT scans, we noted a hyperintense crescent-shaped mass or a well-defined oval-shaped mass with peripheral calcification, usually along the posterior mitral annulus, which was not enhanced after contrast administration. The heterogeneity of the content of the mass was confirmed by the variation in its density, which can range from negative Hounsfield units, suggesting fatty degeneration, to elevated Hounsfield units, suggesting a high protein content and structural calcification. The central hypointensity was secondary to liquefaction of the calcium that fills the center of mass. In this context of our findings in the case presented here, we can conclude that CCT helps confirm the diagnosis, allows the degree of mitral valve stenosis to be evaluated, and offers measures to improve treatment strategies, especially those involving transcatheter or percutaneous transapical mitral valve implantation. Therefore, CCT is considered an excellent tool for the diagnosis of caseous degeneration of the mitral annulus.