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Caseous calcification of the mitral annulus (CCMA) is a rare subtype of mitral annular calcification. It usually appears as a large, round, mass-like calcification with an echolucent core, which may be misdiagnosed as an intracardiac mass, cyst, thrombus or abscess of the mitral valve. We present a case report of CCMA that was misdiagnosed by echocardiography as a benign tumour due to its atypical imaging. The mitral valve mass was resected and it was pathologically confirmed to be a myxoid change with calcification. Echocardiography is the preferred initial diagnostic tool. Myocardial contrast echocardiography (MCE) is used to evaluate the vascularity of intracardiac masses or mass-like lesions, but neither echocardiography nor MCE is reliable for identifying atypical lesions. Cardiac computed tomography is helpful in establishing a diagnosis by showing dense calcifications, while cardiac magnetic resonance imaging is used primarily as a credible tool. We therefore recommend that a diagnosis should be made based on various imaging modalities, if necessary, and operators should be skilled to avoid misdiagnosis.

Caseous calcification of the mitral annulus mimicking benign cardiac tumour of the mitral valve