CTICasesCaseous Mitral Annular Calcification
Imaging findings
Cardiac MR perfusion sequence demonstrates a large focal area of markedly low signal intensity (near-absent perfusion) in the inferior-lateral myocardial wall at the base, corresponding to a large calcified mass identified on the pre-MR chest radiograph and lateral film as a pronounced calcific ball at the mitral annulus. Delayed enhancement imaging shows peripheral rim enhancement of the lesion.
Key takeaways
Caseous mitral annular calcification (MAC) is an uncommon variant of mitral annular calcification in which the calcium undergoes central liquefactive (caseous) necrosis. On CT and MRI it can mimic a myocardial abscess, tumor, or infarct. On MRI, the caseous component appears as a near-signal-void mass on T1 and variable T2 with rim enhancement on delayed gadolinium imaging, which should prompt CT confirmation to avoid misdiagnosis.
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