General Considerations

• Mitral annular calcification is found in 10% of patients > than 50 years of age, most often in women
• It is a chronic degenerative process almost always asymptomatic
• Represents deposition of calcium between the basal infero-lateral ventricular wall and posterior leaflet of mitral valve
• Caseous calcification of the mitral annulus is an uncommon variant of mitral annular calcification with a characteristic appearance
• Represents a mixture of calcium, cholesterol and fatty acids

Clinical Findings

• Patients are usually asymptomatic
• Most are older and almost all have systemic hypertension

Imaging Findings

• Large, spherical calcification that may have sonolucent center on echo
• On MRI, it is of low signal intensity on both T1 and T2-weighted images before and after contrast.
• Usually located on the posterior mitral leaflet
• Contains putty-like, “toothpaste-like” material surrounded by a calcified shell

Differential Diagnosis

• Benign prognosis not to be mistaken for tumor which is in the differential diagnosis

Prognosis

• There are reported cases in which the calcification spontaneously disappeared on follow-up and in another case presumably resolved related to hemodialysis
  
  
  

Caseous Calcification of the Mitral Annulus. Post-contrast enhanced CT axial and coronal scans
through the heart show a large, lobulated calcification at the site of the mitral valve (white arrows)
representing the characteristic appearance of caseous calcification of the mitral annulus.
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