Caseous calcification of the mitral annulus is a rare form of periannular calcification that has a distinct appearance. It generally appears as a large spheric mass like calcification with a central echolucent area that may lead to diagnostic errors. Cardiac imagers should be familiar with this rare form of periannular calcification. We report the case of a 62-year-old woman in whom a suspicious spheric mass like calcification was detected with multislice computed tomography which was performed for coronary artery calcium scoring. Echocardiography displayed the typical findings of caseous calcification of the mitral annulus with central liquefaction.