When performing echocardiography in a 74-year-old woman admitted with non ST elevation myocardial infarction and concomitant colorectal cancer(CC),a dense calcification of the mitral annulus was detected. Differential diagnosis between secondary metastasis and other etiologies of cardiac masses was essential for staging and therapeutic decision-making.Multimodality imaging with echocardiography alongside a computed tomography scan and cardiac magnetic resonance was crucial for the final diagnosis of caseous calcification of the mitral annulus(CCMA).CCMA is briefly reviewed and some possible explanations for the previously undescribed association of CC with CCMA are suggested.