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

Abstract

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.

Keywords: Caseous calcification of mitral (CCMA); mitral valve calcification (MAC); trans-esophageal echocardiography (TEE); transthoracic echocardiography (TTE).

Figure 1

Showing patent LIMA to LAD, left ventriculogram showing normal EF with calcific mass seen at the area of the mitral valve. LIMA, left internal mammary artery; LAD, left anterior descending artery; EF, ejection fraction.

Figure 2

Parasternal long axis view with color Doppler showing round echo dense mass with smooth borders and central areas of echo-lucency involving the posterior mitral annulus.

Figure 3

Echocardiogram showing 2.5×2.5 cm echo dense mass, same is seen in short axis and apical four chamber views.