A 71 Y/O woman presented with atrial fibrillation and multiple attacks of fainting. what is your diagnosis?

  • Answer:

2) Caseous calcification of the mitral annulus

  • Findings:

Axial non-enhanced CT demonstrates large dense calcified mass like lesion involving the mitral valve.

  • Discussion:
    • Caseous calcification of the mitral annulus (CCMA) is a rare form of mitral annular calcification occurring in 0.6% of the cases of MAC .It is a degenerative disorder common in the elderly, in particular women, that typically affects the posterior annulus commissure . This disorder carries a benign prognosis. CCMA rarely may be complicated with mitral valve dysfunction, systemic embolization, or conduction abnormalities. Currently, CCMA is managed conservatively except when significant associated mitral valve dysfunctions or associated distant embolic events.
    • Harpaz D, Auerbach I, Vered Z, Motro M, Tobar A, Rosenblatt S. Caseous calcification of the mitral annulus: a neglected, unrecognized diagnosis. (2001) Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 14 (8): 825-31.
    • Davidson MJ, Cohn LH. Surgical treatment of caseous mitral valve annulus calcification. (2006) The Journal of thoracic and cardiovascular surgery. 131 (3): 738-9.


Courtesy of Taraneh Faghihi,MD, Assistant Professor Department of Radiology,Shahid Modarres Hospital Shahid Beheshti University of Medical Sciences.