A case of caseous calcification of the mitral annulus: A potential source of embolic stroke.

Mitral annular calcification (MAC) is a common finding especially among the elderly. Caseous calcification of the mitral annulus (CCMA) is a rare variant of MAC, which may be mistaken for an intracardiac tumor or abscess. The clinical significance of CCMA and its potential as a source for cerebral embolism is not known. A 76-year-old woman with an acute ischemic stroke was found to have CCMA on echocardiography apparent as a round mass with a central echolucent area and an echo-dense smooth border, in the periannular position of the mitral valve. She subsequently suffered a second embolic stroke. The central cavity of the CCMA seemed to communicate with the left atrium on echocardiography, suggesting the causal relationship between the second brain attack and the CCMA. She was anticoagulated and has not suffered any further strokes. Previous case reports have suggested that CCMA is a benign condition. This detailed report suggests that CCMA may be a potential source of embolic stroke.