Caseous mitral annular calcification: Is it a benign condition?

Caseous mitral annular calcification (cmac) is a variant of mitral annular calcification (mac) with a central liquefaction necrosis. the echocardiographic prevalence of cmac is approximately 0.6% in patients with mac and 0.06–0.07% in large series of patients of all ages. however, the prevalence in necropsy series has been reported to be 2.7%, which indicates that this condition is yet under-recognized. furthermore cmac is probably underappreciated as a source of potentially serious conditions. we report a case of recent stroke associated with cmac diagnosed by transthoracic and confirmed by trans-esophageal echocardiogram (tee). the importance of correct diagnosis of cmac extends beyond the possible complications; since several misdiagnoses of cmac as abscesses and cardiac tumors have been reported leading to inappropriate interventions.