Abstract
WEBSITE FEATURE
A 66-year-old man with a history of hypertension was admitted for exertional chest pain of several months' duration. Chest radiographs showed calcification overlying the left ventricular region of the cardiac silhouette (Fig. 1). Coronary computed tomographic angiography revealed severe calcification, mainly in the apex of the left ventricle (Fig. 2). The calcification was fine and spherical, resembling a broken eggshell. A left ventricular aneurysm with thrombus formation was also noted (Fig. 3).
Fig. 1 Chest radiographs in A) posteroanterior and B) lateral views show cardiomegaly and calcification in the left ventricular region of the heart.
Fig. 2 Coronary computed tomographic angiograms in A) axial long-axis view and B) 3-dimensional view with color-flow and volumetric technique show calcification with a “broken eggshell” appearance, chiefly in the left ventricular apex. A left ventricular aneurysm with low-density thrombus is also apparent.
Fig. 3 Left ventriculogram shows a calcified aneurysm with a crescent-shaped thrombus in the left ventricular apex.
Real-time motion image is available at www.texasheart.org/journal.
Comment
Calcification overlying the left side of the heart can involve either the myocardium or the pericardium. Pericardial calcification usually occurs over the right-sided cardiac chambers, so it can be seen better on lateral radiographs.1 Myocardial calcification is a manifestation of either metastatic or dystrophic calcium deposition in the myocardium. Dystrophic myocardial calcification is most commonly seen in patients who have sustained a sizable infarction and survived longer than 6 years thereafter. Myocardial calcification is usually thin and curvilinear in shape. Curvilinear calcification at the left ventricular apex strongly suggests an aneurysm.1,2 Rarely, calcification can have a spherical or platelike appearance. This patient's lengthy survival after aneurysm formation enabled extensive calcification of the aneurysmal wall. The spherical eggshell-like shape was unusual.
Supplementary Material
Footnotes
Address for reprints: Ki-Dong Yoo, MD, Department of Internal Medicine, Division of Cardiology, St. Vincent's Hospital, #93-6, Ji-dong, Paldal-ku, Suwon 442-723, Gyunggi-Do, ROK, E-mail: yookd@catholic.ac.kr
References
- 1.MacGregor JH, Chen JT, Chiles C, Kier R, Godwin JD, Ravin CE. The radiographic distinction between pericardial and myocardial calcifications. AJR Am J Roentgenol 1987; 148(4):675–7. [DOI] [PubMed]
- 2.Aras D, Topaloglu S, Demirkan B, Deveci B, Ozeke O, Korkmaz S. Porcelain heart: a case of massive myocardial calcification. Int J Cardiovasc Imaging 2006;22(1):123–6. [DOI] [PubMed]
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