title: A large cardiac mass: diagnosis of caseous mitral annular calcification and determining optimum management strategy.
abstract: 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 2.0 × 2.3 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.
authors.affiliation: UCSD School of Medicine, La Jolla, CA, USA.
authors.forename: Emanuel A
authors.initials: EA
authors.lastname: Shapera
authors.affiliation: UCSD School of Medicine, La Jolla, CA, USA ; Department of Radiology, UCSD School of Medicine, La Jolla, CA, USA.
authors.forename: Afshin
authors.initials: A
authors.lastname: Karimi
authors.affiliation: UCSD School of Medicine, La Jolla, CA, USA ; Department of Medicine and Division of Cardiovascular Medicine, UCSD Sulpizio Family Cardiovascular Center, La Jolla, CA 92093, USA.
authors.forename: Luis R
authors.initials: LR
authors.lastname: Castellanos