Mangeet Chahal, Peter Temesy-Armos and William J. Stewart
Article first published online: 10 MAR 2011 | DOI: 10.1111/j.1540-8175.2010.01321.x
A 73-year-old woman was found to have a 1.4 × 3.0 cm heterogeneous echodensity with smooth borders and central echolucency associated with a dynamic left ventricular outflow tract gradient and episodic chest pain. Although mitral annular calcification is a common manifestation, this case represents caseous calcification of the mitral annulus, which is a rare variant with an estimated prevalence of 0.068%. It should not be misinterpreted as an intracardiac tumor, abscess or cyst, as was the initial assumption in this case. The importance of dynamic left ventricular outflow tract obstruction and fluctuations in calcium levels are also discussed.