A Large Cardiac Mass : Diagnosis of Caseous Mitral Annular Calcification and Determining Optimum Management Strategy

Abstract EN

A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible stroke with a head-neck CT scan and a transthoracic echocardiogram.

The head-neck CT scan was unremarkable, but the echocardiogram was notable for a 2.0×2.3 cm heterogeneous echodensity attached to the mitral valve.

After a transesophageal echocardiogram and chest CT scan, the mass was determined to be a caseous mitral annular calcification, CMAC.

This entity is a rare variant of MAC with an estimated prevalence of 0.068%.

Echocardiographic techniques can distinguish CMAC from other intracardiac masses such as tumor, cyst, or abscess.

CMAC is associated with cerebrovascular accidents; however, optimal treatment is controversial given the rarity of this clinical finding.

Management strategies should be tailored based on the patient’s presentation, risk factors, and overall clinical circumstances.