Acute myeloid leukemia (AML) patients encounter complications mainly due to their underlying disease or chemotherapy. Although they are at high risk for both hemorrhagic and thrombotic complications, thrombotic vascular complication as an initial manifestation is less common and rarely reported, especially in non-acute promyelocytic leukemia (non-APML). A 58-year-old female with no co-morbidity presented with fever, decreased appetite, headache, and weakness in her left upper and lower limbs. Laboratory findings showed hyperleukocytosis with 90% blast cells and thrombocytopenia (50,000/dl). While investigated and conservatively managed, she developed a seizure and loss of consciousness on the same day and was admitted to the intensive care unit. Computed tomography showed a massive right infarct in the middle cerebral artery territory with a significant midline shift. Flow cytometry indicated the diagnosis of non-APML; chemotherapy, platelet transfusion, unfractionated heparin, mechanical ventilation, and other supportive treatments were started. While managing this case, we faced challenges in decision-making on thrombolysis, craniotomy, and chemotherapy. The case highlights the salient points and dilemmas in managing such an acutely ill patient in critical care.

Mitral annular calcication (mac) is a chronic degenerative process of the brous support structure of the mitral valve. The reported prevalence of mac is about 8% in an unselected, general population and increases with age, in the presence of cardiovascular risk factors. It is also observed that mac has a female gender predominance with a prevalence of 12%.Its clinical relevance comes from mac's association with an increased rate of mortality and cardiovascular disease (cvd). Occasionally, a chest x-ray might reveal calcic demarcation of the mitral annulus. Mac is usually seen as a c-, j-, u- or o-shape, with the open part lying at the site of the aortic outow tract. Lateral projection usually better demonstrates mitral calcication because the overlying spine and main left lower lobe arteries in the posteroanterior view may mask its visualization. Fluoroscopy during coronary angiography can also show mitral calcication, but is not an accurate modality for assessment of the extent of mac. Mac is usually an incidental nding in patients being evaluated for cardiovascular or pulmonary diseases. The presence of a calcied mitral annulus is asymptomatic, which precludes true evaluation of the prevalence of mac in the general population. We are presenting a case report of a female patient who is a known case of chronic obstructive pulmonary disease and had an incidental nding of mitral annular calcication on chest radiograph that was later conrmed by computed tomography (ct) and 2d echo ndings.