Imaging Case of the Week 131

The following erect AP chest x-ray is from a 80 year old with chest pain. There is an incidental finding on the chest-ray. Can you spot it?


AP erect cxr

The lateral x-ray from the same patient (sub-optimal quality), as shown below, may provide an additional clue.

Lateral cxr

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The incidental finding on the chest x-ray is mitral annular calcification (MAC) – there is heavy calcification of the mitral valve annulus.

Mitral annular calcification

Mitral annular calcification lat view


Atherosclerotic calcification of the mitral annulus occurs in approximately 10% of the elderly population. It appears as a circular/ovoid/C-or-J shaped calcification in the mitral annulus and can lead to mitral incompetence.

MAC and atherosclerosis share similar risk factors and the presence of MAC is associated with a higher incidence of cardiovascular disease and cardiovascular mortality. There is no specific therapy for MAC but risk factors such as hypertension and hyperlipidaemia require treatment.

Reference: Fundamentals of Diagnostic Radiology by Brant and Helms &