Caseous calcification of the mitral annulus: An under recognized differential diagnosis of mitral annular mass

Area of Science:

• Cardiology
• Medical Imaging

Background:

• Mitral annular calcification (MAC) is common, particularly in older adults and those with cardiovascular risk factors.
• Cardiac masses require accurate differentiation, as they can represent various pathologies, including tumors and thrombi.
• Caseous calcification of the mitral annulus is a rare variant of MAC.

Observation:

• A 55-year-old female with obesity, diabetes, hypertension, and a history of stroke presented for echocardiography.
• Transthoracic echocardiography revealed a distinct, rounded mass at the posterior mitral annulus.
• The mass exhibited a hyperechoic outer border and central echolucency.

Findings:

• Transesophageal and 3D echocardiography confirmed the mass as caseous calcification of the mitral annulus.
• The characteristic imaging appearance facilitated diagnosis, distinguishing it from other cardiac masses.
• The patient's multiple cardiovascular risk factors are consistent with associations seen in MAC.

Implications:

• Caseous calcification of the mitral annulus should be considered in the differential diagnosis of cardiac masses.
• Characteristic echocardiographic findings enable non-invasive diagnosis of this rare condition.
• Recognizing this entity is crucial for appropriate patient management and avoiding unnecessary interventions.