CTICasesCaseous Mitral Annulus Calcification (CMAC)
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Imaging findings
An incidental finding on a pulmonary vein mapping CT was dense material throughout the left ventricle, which was initially confusing and raised questions about a ventricular septal defect versus a more diffuse process. Some areas appeared low density. A delayed phase showed some very low-density areas, and some areas were higher density than the blood pool. Review of a non-contrast CT from a couple years prior revealed extensive calcification, consistent with caseous mitral annulus calcification.
Key takeaways
Caseous mitral annulus calcification can be an incidental finding. It can be confusing on contrast-enhanced CT, sometimes mimicking a mass or thrombus, so a delayed acquisition or prior non-contrast study can be helpful. This condition may wax and wane in appearance, from pasty white to more necrotic or low density. Surgeons generally dislike operating on these as the material can be putty-like, leading to leaks or embolization, though it can cause valvular insufficiency.
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