Caseous Mitral Annular Calcification and the Utility of Multimodality Cardiac Imaging: A Case Report

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.