Caseous calcification of the mitral valve annulus

Case contributed by Dr. Emad Moussa


55 years old female patient developed attacks of fainting, initial investigation demonstrated abnormal ECG findings with atrial fibrillation pattern. Additional echocardiography demonstrated cardiac mass .

Patient Data

Age: 55
Gender: Female

Axial non-enhanced CT demonstrates large dense calcified mass lesion involving the posterior commisure of the mitral valve

Cardiac MRI showed intense blooming of the entire mass due to calcifications (axial gradient echo), the mass primarily originated and extended along the mitral valve annulus posterior surface (sagittal gradient echo) and was associated with high grade mitral valve regurgitation manifested by the strong aliasing toward the atrium during ventricular contraction (axial gradient echo arrow). The mass demonstrated intense enhancement at the delayed scans.

Case Discussion

Caseous calcification of the mitral annulus (CCMA) is a rare form of mitral annular calcification occurring in 0.6% of the cases of MAC 1.  It is a degenerative disorder common in the elderly, in particular women, that typically affects the posterior annulus commissure 1. This disorder carries a benign prognosis but most of the cardiologists are not familiar with, and may misdiagnose it as a (benign or malignant) cardiac tumor, vegetation or calcified thrombus 2,3,4 therefore a punctual differential diagnosis is required. CCMA rarely may be complicated with mitral valve dysfunction, systemic embolization, or conduction abnormalities 5. CCMA may demonstrate dynamic course, it may resolve spontaneously or transform back to isolated form of simple mitral annulus calcification. However, it may recur even after surgical excision 6. Currently CCMA is managed conservatively except in significant associated mitral valve dysfunctions or associated distant embolic events 4.


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Case information

rID: 47717
Case created: 30th Aug 2016
Last edited: 16th Sep 2016
Systems: Chest, Cardiac
Inclusion in quiz mode: Excluded
Excluded from licensing

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