Key result
Multimodality imaging with TEE, CMR, and CT successfully confirms caseous mitral annular calcification.
Why the study?
Caseous mitral annular calcification can be misdiagnosed on echocardiogram as tumors, abscesses, vegetations, or thrombi, necessitating advanced imaging modalities for further evaluation in equivocal cases.
Case Report (n=1)
Multimodality imaging, including TEE, CMR, and cardiac CT, is useful for confirming the diagnosis of caseous mitral annular calcification when transthoracic echocardiography is equivocal.
Echocardiographic misdiagnosis of CMAC as tumor or vegetation warrants advanced imaging; case reports leave open standardized diagnostic criteria.
Mitral annular calcification (MAC) is a common incidental finding, often associated with conditions of abnormal calcium metabolism. Caseous mitral annular calcification (CMAC) is a less common variant of mitral annular calcification that involves central liquefaction necrosis. On echocardiogram, CMAC can be misdiagnosed with other conditions, including tumors, abscesses, vegetations, or thrombi. In equivocal cases, advanced imaging modalities are necessary for further evaluation. We report a nondiagnostic case of CMAC found on transthoracic echocardiogram that required transesophageal echocardiogram, cardiac magnetic resonance imaging, and gated cardiac computed tomography for confirmation. Our patient with asymptomatic CMAC was clinically monitored without need for intervention.
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Nguyen et al. (2025) conducted a case report in Caseous mitral annular calcification (n=1). Multimodality cardiac imaging was evaluated on Diagnosis confirmation. Multimodality cardiac imaging, including transesophageal echocardiogram, cardiac MRI, and gated cardiac CT, successfully confirmed the diagnosis of caseous mitral annular calcification.
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