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A large cardiac mass: diagnosis of caseous mitral annular calcification and determining optimum management strategy

Emanuel A Shapera1, Afshin Karimi2, Luis R Castellanos3

  • 1UCSD School of Medicine, La Jolla, CA, USA.

Case Reports in Medicine
|July 17, 2014
PubMed

Insights

A rare cardiac mass, caseous mitral annular calcification (CMAC), was identified in a patient presenting with stroke-like symptoms. Differentiating CMAC from other masses is crucial for appropriate patient management.

Area of Science:

  • Cardiology
  • Radiology
  • Pathology

Background:

  • A 64-year-old woman presented with dizziness and blurry vision, prompting an evaluation for stroke.
  • Initial imaging revealed a heterogeneous echodensity on the mitral valve, necessitating further investigation.

Purpose of the Study:

  • To report a rare case of caseous mitral annular calcification (CMAC).
  • To highlight the diagnostic challenges and management considerations for CMAC.

Main Methods:

  • Head-neck CT scan and transthoracic echocardiogram were performed.
  • Transesophageal echocardiogram and chest CT scan were utilized for detailed mass characterization.
  • Distinguishing CMAC from other intracardiac masses using echocardiography.

Main Results:

  • The echocardiogram identified a 2.0 × 2.3 cm heterogeneous echodensity on the mitral valve.
  • Subsequent imaging confirmed the mass as caseous mitral annular calcification (CMAC), a rare variant of mitral annular calcification (MAC).
  • CMAC has an estimated prevalence of 0.068% and is associated with cerebrovascular accidents.

Conclusions:

  • Caseous mitral annular calcification (CMAC) is a rare cardiac finding that can mimic other intracardiac masses.
  • Echocardiography plays a key role in differentiating CMAC from tumors, cysts, or abscesses.
  • Optimal treatment for CMAC remains controversial and should be individualized based on clinical presentation and risk factors.

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