Caseous calcification of posterior mitral annulus: a forgotten benign condition mimicking atrial mass

Caseous calcification of posterior mitral annulus is considered a variant of mitral annular calcification and accounts for less than 1% cases of mitral valve calcification (MAC). Usually benign and asymptomatic and has typical features on imaging studies but may contribute to unnecessary investigations and interventions in some patients, transthoracic echocardiography (TTE) is most useful tool in the diagnosis of this condition, whether it is associated with increased risk of atherosclerosis is unknown. We are presenting a case of caseous calcification of posterior mitral annulus that is discovered during elective coronary angiography in a patient with extensive history of coronary heart disease who had abnormal stress test.