Caseous mitral annular calcifications: Multimodality imaging characteristics

Figure 4 Transverse, non-gated, post-contrast CT images at a level through the heart are shown with mediastinal (A) and bone (B) windows and level settings (kVp = 120, mAs = 220, DFOV = 310 mm). An ovoid mass of caseous mitral annular calcifications is seen high along the posterior portion of the mitral annular leaflet (white arrows). Although there is motion artifact, there is differing attenuation between the calcific rim of this structure (white arrowhead) and the central homogeneous liquefied calcium, which is slightly less hyperattenuating (black arrowhead). This difference is seen on the bone window image (B), but is not demonstrable on the mediastinal window/level settings (A). Based on correlation with the scout view (not shown), this was felt to be the cause of the nodule seen on plain radiography (Figure 3).