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Case Reports in Medicine
Volume 2014 (2014), Article ID 637374, 4 pages
Case Report

A Large Cardiac Mass: Diagnosis of Caseous Mitral Annular Calcification and Determining Optimum Management Strategy

1UCSD School of Medicine, La Jolla, CA, USA
2Department of Radiology, UCSD School of Medicine, La Jolla, CA, USA
3Department of Medicine and Division of Cardiovascular Medicine, UCSD Sulpizio Family Cardiovascular Center, La Jolla, CA 92093, USA

Received 8 April 2014; Accepted 21 May 2014; Published 17 June 2014

Academic Editor: W. Zidek

Copyright © 2014 Emanuel A. Shapera et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


A 64-year-old woman with dizziness and blurry vision underwent an evaluation for a possible stroke with a head-neck CT scan and a transthoracic echocardiogram. The head-neck CT scan was unremarkable, but the echocardiogram was notable for a  cm heterogeneous echodensity attached to the mitral valve. After a transesophageal echocardiogram and chest CT scan, the mass was determined to be a caseous mitral annular calcification, CMAC. This entity is a rare variant of MAC with an estimated prevalence of 0.068%. Echocardiographic techniques can distinguish CMAC from other intracardiac masses such as tumor, cyst, or abscess. CMAC is associated with cerebrovascular accidents; however, optimal treatment is controversial given the rarity of this clinical finding. Management strategies should be tailored based on the patient’s presentation, risk factors, and overall clinical circumstances.