Multiple Right Ventricular Calcified Amorphous Tumors: A Rare Histologic Entity with an Exceptional Anatomical Presentation

Background: Primary cardiac tumors are exceptionally rare, and among them, calcified amorphous tumors (CATs) represent a unique non-neoplastic entity with poorly understood pathogenesis. Despite their benign histology, CATs can mimic malignant or embolic lesions on imaging and often present with nonspecific or incidental findings. Most reported cases are solitary and located in the mitral annulus, with multifocal involvement being exceedingly rare. We present an anatomically exceptional case of two synchronous CATs confined to the right ventricle (RV), emphasizing the diagnostic complexity and clinical implications of this rare condition. Case presentation: A 63-year-old woman with no relevant comorbidities was referred for progressive exertional dyspnea and constitutional symptoms. Transthoracic echocardiography identified two mobile, hyperechoic masses within the RV, attached to the tricuspid subvalvular apparatus and causing moderate-to-severe tricuspid regurgitation. Cardiac magnetic resonance imaging (CMR) demonstrated well-circumscribed, avascular lesions with mild late gadolinium enhancement. Computed tomography (CT) confirmed dense calcifications and excluded extracardiac malignancy. The patient underwent surgical excision of both lesions and tricuspid valve replacement. Histopathological analysis revealed amorphous eosinophilic material with nodular dystrophic calcification, consistent with the diagnosis of CAT. Discussion: This case expands the known anatomical spectrum of CATs, illustrating an exceedingly rare presentation of synchronous RV lesions in a patient without conventional predisposing factors. It underscores the critical role of multimodality imaging in the preoperative assessment and highlights the necessity of histopathological confirmation for accurate diagnosis and optimal management of atypical cardiac masses.