Caseous calcification of the mitral annulus: An under recognized differential diagnosis of mitral annular mass.

A 55-year-old obese, diabetic and hypertensive female patient with history of cerebrovascular stroke 2 years ago was referred for echocardiography. Transthoracic echocardiography revealed a well-defined rounded mass located at the posterior mitral annulus. The mass had a sharp hyperechoic outer border and a central echolucency. Transesophageal and three-dimensional echocardiography confirmed these findings consistent with caseous calcification of the mitral annulus. This case presents a rare variant of mitral annular calcification considered in the differential diagnosis of cardiac masses that can be recognized by its characteristic appearance on echocardiography. As with mitral annular calcification, multiple cardiovascular risk factors are commonly associated.