Caseous calcification of the mitral annulus is a rare entity in cardiac imaging. We present CT and magnetic resonance imaging (MRI) in a patient evaluated for severe mitral valve regurgitation with such calcified cardiac mass in the thickened basal wall of the left ventricle. Despite good visualization of the mass both with 64-slice multidetector CT and MRI, the characterization of the lesion was difficult. The most critical finding was the presence of a hyperdense mass with an even denser peripheral rim on pre-contrast CT images. The mass did not enhance after X-ray contrast agent administration. We discuss the preoperative differential for calcified intramyocardial mass.
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