Key result
Caseous mitral annular calcifications appear as ovoid, mass-like structures with homogeneous hyperattenuation surrounded by peripheral calcifications on multimodality imaging.
Case Report (n=3)
Caseous mitral annular calcification is an under-recognized entity that presents as a mass-like structure on imaging, requiring careful multimodality assessment to avoid misdiagnosis.
Recognizing this pattern may prevent misdiagnosis as tumor or thrombus; case reports leave open need for validation.
The authors report herein a series of 3 patients with caseous mitral annular calcifications (MAC). One of the patients presented with mass-like, caseous MAC as an incidental finding on a staging computed tomography (CT) for metastatic colorectal carcinoma. Another patient presented with a nodule on a chest radiograph, which was later found on CT to be due to caseous MAC. In the third patient, caseous MAC was initially detected on echocardiography, and was further evaluated with CT and cardiac magnetic resonance imaging. In all three patients, the appearances posed a diagnostic dilemma. The appearance of caseous MAC is dissimilar to non-caseous MAC and is usually seen as an ovoid, mass-like structure, with homogeneous hyperattenuation, representing a liquefied form of calcium and proteinaceous fluid. This homogeneous center is surrounded by peripheral, shell-like calcifications. Caseous MAC is likely an under-recognized entity and may present a diagnostic dilemma at CT, magnetic resonance imaging, or echocardiography.
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Jabi E. Shriki (2010) conducted a case report in Caseous mitral annular calcifications (n=3). Multimodality imaging (CT, MRI, echocardiography) was evaluated on Imaging characteristics of caseous MAC. Caseous mitral annular calcifications appear as ovoid, mass-like structures with homogeneous hyperattenuation surrounded by peripheral calcifications on multimodality imaging.
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