Case History:
A 54-year-old woman, treated for invasive ductal carcinoma of the left breast by mastectomy, chemotherapy and radiotherapy 8 years ago, presented at the cardiology department for a systematic echocardiography before cataract surgery. Echocardiography showed a soft tissue mass with central echolucencies of the posterior mitral annulus blocking the posterior leaflet of the valve with mitral regurgitation. There were neither acoustic shadowing nor blood flow on color Doppler (figure 1). The diagnosis of a cardiac tumor, particularly a metastasis, was suggested. The patient underwent a cardiac magnetic resonance (CMR) within few days (figure 2). Multi-planar cine images showed a low signal mass of the posterior mitral annulus blocking the posterior leaflet with mitral regurgitation, extending to the myocardium. The mass was in high signal on T1 black blood weighted images and was confused with the blood on STIR weighted images. Late gadolinium enhancement (LGE) sequences showed peripheral intense enhancement. A cardiac CT with prospective gating and no contrast material administration showed that the mass was a huge calcification of the posterior mitral annulus with lower density than the other calcifications of the mitral and the aortic annuli. Review of the radiological data of the patient at the work up of her breast cancer showed tiny calcifications of the mitral annulus (figure 3). Cardiac tumor was eliminated and the diagnosis of CMAC was retained.