Caseous Calcification of the Mitral Annulus leading to symptomatic mitral stenosis.

Caseous calcification of the mitral annu-lus (CCMA) is a rare variant of mitral annular calcification, which can be difficult to diagnose and can be misdiag-nosed as a cardiac tumour or abscess. Multimodality imaging is important for the diagnosis of this entity and to avoid unnecessary surgical treatment. We present the case of a 77-year-old female patient with initially asymp-tomatic CCMA who later developed third degree atrioven-tricular heart block. Four years after the initial diagnosis, she was admitted to hospital for acute heart failure due to mitral stenosis. Multimodality imaging including transthoracic and transoesophageal echocardiography, and computed tomography showed an increase in the size of the caseous calcification with symptomatic mitral stenosis.