Caseous mitral annular calcification (CMAC) is a rare variant of mitral annular calcification (MAC), most commonly seen in elderly women on the posterior mitral annulus. CMAC is usually diagnosed incidentally and has a benign course. However, it may cause abnormal blood flow across the mitral valve resulting in mitral regurgitation, and rarely, functional mitral stenosis. MAC occurs in 10 percent of the population, while CMAC occurs in 0.06 percent. Most cases of CMAC are misdiagnosed as other intracardiac masses, such as tumors, abscesses, thrombi, and vegetation.
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