Presentation
Angina type syncope. LAD and RCA calcium on HRCT.
Patient Data
1. Severe triple vessel coronary artery calcification and total Agatston score is 758.
2. There is borderline severe (50 to 55%) luminal stenosis of the proximal right coronary artery and mild luminal narrowing of the remaining vessels secondary to eccentric calcified atherosclerotic plaques.
Incidental finding: Significantly hyperdense (HU 564 to 621), well-defined, smooth-edged, 2.3 cm x 1.5 cm density with peripheral calcification with no significant enhancement on arterial phase situated within the posterior mitral valve annulus. Appearances are highly suggestive of caseous calcification of the mitral valve.
Case Discussion
Caseous calcification of the mitral annulus is a relatively rare variant.
Most commonly, it is an incidental finding on cardiac CT or MRI scans. On CT, it appears as a well-defined hyperdense oval-shaped mass with peripheral calcification, most commonly situated along the posterior mitral annulus. There is a lack of contrast enhancement. The central hyperdensity is thought to be secondary to the liquefactive material.