Fig. 1

Exemplary characteristics of CMAC (case 6). Echo: apical long axis view A with the hyper-echoic mass (arrow) at the lateral mitral valve annulus with acoustic shadowing; short-axis view B with a blurred demarcation of the hyper-echoic capsule and hypo-echoic core. MRI: cardiac 4-chamber view in steady state free precision sequence C with the iso-intense mass (arrow) to the adjacent myocardium (star), but with a clear hypo-intense demarcation from intracavitary blood (plus sign); T1-weighted sequence with the hypo-intense mass (arrow) and less intense core in T2-weighted sequence (arrow) compared to the myocardium (star) (D; top left and top right); first pass perfusion with low signals of vascularisation compared to myocardium (star) and intraventricular blood (plus sign) (D; bottom left); late gadolinium enhancement with very low signal in the core, but peripheral bright border (arrow) (D; bottom right); CT: precontrast hyperattenuation of the CMAC mass with peripheral calcifications (E) and no accumulation of contrast agent (D). CMAC caseous mitral annular calcification, Echo transthoracic echocardiography, MRI cardiac magnetic resonance imaging, CT cardiac computed tomography