Key result
Multimodality imaging and pathology confirm sterile caseous mitral annular calcification presenting as multifocal stroke.
Why the study?
Multifocal stroke with positive antiphospholipid antibodies can obscure alternative embolic etiologies such as embolizing caseous calcification of the mitral annulus.
Case Report (n=1)
Answers are grounded in this paper and cite their sources.
Positive antiphospholipid antibody testing should not preclude evaluation for alternative structural embolic sources like caseous calcification of the mitral annulus, which may require surgical evaluation when accompanied by extensive embolization.
BACKGROUND: Multifocal stroke with positive antiphospholipid antibodies (aPLs) can obscure alternative embolic etiologies. We present a case of embolizing caseous calcification of the mitral annulus (CCMA). CASE SUMMARY: A 77-year-old woman presented with acute gait instability and mild left-sided weakness. Laboratory evaluation revealed positive aPLs. Neuroimaging demonstrated multifocal acute infarcts with calcified cerebral emboli. Transesophageal echo revealed extensive mitral annular calcification with an attached mobile echodense mass. Final surgical pathology confirmed a sterile CCMA. DISCUSSION: Concurrent positive aPL testing complicated the evaluation of multifocal embolic strokes. Multimodality imaging led to the appropriate diagnosis and management of CCMA. TAKE-HOME MESSAGES: Positive aPL testing should not preclude continued evaluation for alternative structural embolic sources. CCMA with extensive embolization warrants surgical evaluation because anticoagulation alone does not eliminate the embolic risk.
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AlHoda et al. (2026) conducted a case report in Embolizing caseous calcification of the mitral annulus (CCMA) with positive antiphospholipid antibodies (n=1). Multimodality imaging and surgical resection was evaluated on Diagnosis and surgical pathology confirmation of sterile CCMA. Multimodality imaging and surgical pathology identified sterile caseous calcification of the mitral annulus in 1 patient (77-year-old woman) with multifocal stroke and positive aPLs.
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