Key result
Multimodal imaging successfully identified a 12x14 mm caseous mitral annular calcification mimicking a cardiac mass, allowing for conservative medical management without surgery.
Why the study?
Caseous mitral annular calcification is a rare variant of mitral annular calcification that can mimic cardiac neoplasms, making multimodal imaging essential for accurate diagnosis.
Case Report (n=1)
No
Multimodal imaging, particularly cardiac MRI, is essential for accurately diagnosing caseous mitral annular calcification and avoiding misdiagnosis of a cardiac mass, allowing for conservative management in patients without severe complications.
May support conservative management of caseous mitral annular calcification via multimodal imaging; single case leaves generalizability open.
Caseous mitral annular calcification (CMAC), a rare variant of mitral annular calcification (MAC), predominantly affects older adults. CMAC represents a very small fraction of MAC, and it features a necrotic core with peripheral calcifications, mimicking neoplasms. Multimodal imaging is essential for diagnosis. We present a case of an 86-year-old hypertensive male patient who presented with exertional dyspnea. Transthoracic echocardiography revealed severe left ventricular hypertrophy, a left cardiac mass, and severe MAC. Cardiac MRI confirmed CMAC (12×14 mm calcified mass). He was managed medically and surveilled with serial echocardiograms. While asymptomatic cases may regress, complications (emboli, valve dysfunction) warrant surgery. Advanced imaging prevents misdiagnosis, guiding intervention. CMAC necessitates multimodal imaging for accurate diagnosis. Conservative management with serial monitoring is appropriate in asymptomatic patients, underscoring the importance of clinician awareness to mitigate complications. Early recognition ensures optimal outcomes in these rarer etiologies.
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Singh et al. (2025) conducted a case report in Caseous mitral annular calcification (n=1). Conservative medical management and serial imaging was evaluated. Multimodal imaging successfully identified a 12x14 mm caseous mitral annular calcification mimicking a cardiac mass, allowing for conservative medical management without surgery.
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