We present the case of a 90-year-old diabetic male and medically managed three-vessel coronary artery disease with evidence of an oval, nonmobile echo-density located on the posterior mitral valve annulus measuring two centimeters in diameter without significant impingement of the mitral valve on initial screening echocardiogram which was initially thought to be prominent mitral annular calcification which was later confirmed to be a rare case of caseoma as confirmed by both cardiac magnetic resonance (CMR) as well as coronary computed tomographic angiography (CCTA).

This is the case of a twenty-two-year-old active duty male soldier with nonexertional chest pain and worsening performance on his physical fitness test. His history was significant for a diagnosis of dextrocardia upon entry to the military. On acute presentation to the emergency department, he was deemed a candidate for the expedited coronary computed tomographic angiography (CCTA) protocol to assess for a possible anatomic cause of his symptoms. CCTA revealed the presence of an anomalous right pulmonary vein draining into the inferior vena cava. Additionally, the imaging showed dextroversion of the heart, dilation of the inferior vena cava, right atrium, and right ventricle, as well as a hypoplastic right lung, a collection of findings consistent with scimitar syndrome and not dextrocardia.

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