Learning Radiology xray montage

Caseous Calcification of the Mitral Annulus

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


  • 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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Caseous Calcification of the Mitral Valve Ring. Marcu , C, Ghantous, A and Prokop, E. Lung and Circulation. Volume 15, Issue 3, June 2006, Pages 187-188.

Caseous Calcification of the Mitral Annulus. H Arora; P Madan; L Simpson and R Stainback. Tex Heart Inst J. 2008; 35(2): 211–213. 2008

Cardiovascular magnetic resonance features of caseous calcification of the mitral annulus. L Monti; E Renifilo; M Profili and L Balzarini. Cardiovasc Magn Reson. 2008; 10(1): 25.