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Big MAC: caseous calcification of the mitral annulus referred for possible cardiac tumor

Mangeet Chahal1, Peter Temesy-Armos, William J Stewart

  • 1Department of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.

Echocardiography (Mount Kisco, N.Y.)
|March 12, 2011
PubMed

Insights

Caseous calcification of the mitral annulus is a rare condition mimicking cardiac tumors. This case highlights its distinct features and implications for dynamic left ventricular outflow tract obstruction.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Pathology

Background:

  • Mitral annular calcification (MAC) is common, but caseous calcification of the mitral annulus (CCMA) is a rare variant.
  • CCMA has an estimated prevalence of 0.068% and can be mistaken for intracardiac tumors, abscesses, or cysts.

Observation:

  • A 73-year-old woman presented with a 1.4 × 3.0 cm heterogeneous echodensity with smooth borders and central echolucency.
  • This finding was associated with a dynamic left ventricular outflow tract (LVOT) gradient and episodic chest pain.

Findings:

  • The observed echodensity was diagnosed as caseous calcification of the mitral annulus, not an intracardiac tumor.
  • The patient experienced chest pain attributed to dynamic LVOT obstruction.

Implications:

  • Accurate diagnosis of CCMA is crucial to avoid misinterpretation and unnecessary interventions.
  • Understanding the link between CCMA, dynamic LVOT obstruction, and chest pain is vital for patient management.
  • This case underscores the importance of considering rare variants in cardiac imaging and their clinical significance.

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