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title: "Cardiac Calcifications"
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docid: "c53ad786-4464-4a04-a3e9-ccd286e1f8fc"
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authors:
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- key: "df804626-c042-4296-96e3-836a6da50fd6"
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value: "Gregory Kicska, MD, PhD"
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breadcrumbs:
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-
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name: "Cardiac"
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slug: "cardiac"
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treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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-
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name: "Cardiac Calcifications"
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slug: "cardiac-calcifications"
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treeNodeId: null
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category: "Cardiac"
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documentVersionId: "76a1cfbf-a803-4de9-be9e-02798943ac36"
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imageCount: 9
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lastUpdated: "03/17/22"
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pageDescription: "Cardiac Calcifications"
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pageKeywords: "Cardiac, Differential Diagnosis, Cardiac Calcifications"
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pageTitle: "Cardiac Calcifications | STATdx"
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enhancedTitle: "Cardiac Calcifications"
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type: "DDX"
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breadcrumbs:
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- "Cardiac"
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- "Differential Diagnosis"
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- "Cardiac Calcifications"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Most common pitfall is misidentifying which anatomic structure is calcified
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- Cardiac calcifications more common in dialysis patients
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- ## Helpful Clues for Common Diagnoses
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- **Coronary Artery**
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- Curvilinear, parallel lines most commonly in proximal coronary arteries and at vessel branch points
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- Amount of calcium correlates with amount of coronary plaque but not degree of stenosis
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- Presence correlates with risk of future cardiac events
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- **Mitral Valve**
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- Annular calcifications
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- Associated with mitral valve insufficiency
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- Valvular calcifications
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- Suggests stenosis, most often due to rheumatic heart disease
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- **Aortic Valve**
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- Calcification burden correlates with stenosis severity
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- Bicuspid valve
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- Young patients
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- Coexistent coarctation
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- Degenerative
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- Patients > 60 years of age
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- Risk factor for coronary atherosclerosis
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- Rheumatic heart disease
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- Patients > 35 years of age
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- Coexistent mitral valve stenosis
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- ## Helpful Clues for Less Common Diagnoses
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- **Pericardial**
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- Associated with constrictive pericarditis
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- **Myocardial**
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- Indicates prior infarction; myocardial fat will likely be present
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- **Other Cardiac Valves and Chambers**
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- Tricuspid valve
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- Most commonly due to rheumatic heart disease; mitral and aortic valve will likely be calcified
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- Pulmonary valve
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- Most commonly due to congenital pulmonary stenosis
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- Atrial calcifications
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- Associated with severe atrial dilation
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- ## Helpful Clues for Rare Diagnoses
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- **Mass**
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- Chronic thrombus
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- Atrial appendage or adjacent to infarcted myocardium
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- Metastasis
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- History of primary tumor
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- Atrial myxoma
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- Look for characteristic location and attachment
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## Images
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### Selected Images
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**Coronary Arteries**
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*Axial oblique CECT MIP shows discrete calcifications in a linear arrangement <img src='img/arrows/WS.png'/> in a patient with LAD atherosclerosis. Note the presence of noncalcified plaque <img src='img/arrows/WO.png'/>.*
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**Coronary Arteries**
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*Axial oblique CECT MIP shows discrete calcifications in a linear arrangement <img src='img/arrows/WS.png'/> in a patient with LAD atherosclerosis. Note the presence of noncalcified plaque <img src='img/arrows/WO.png'/>.*
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**Mitral Valve Leaflets**
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*Frontal radiograph shows characteristic reversed C-shaped calcification <img src='img/arrows/BS.png'/> indicating mitral valve annular calcification. This calcification pattern is very common and, unlike leaflet calcification, not usually associated with stenosis.*
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**Mitral Valve Leaflets**
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*Axial NECT shows mitral valve leaflet calcifications in a patient with mitral stenosis <img src='img/arrows/WS.png'/> presumed to be due to rheumatic heart disease. Note the enlarged left atrium and left atrial calcifications <img src='img/arrows/WO.png'/>. The patient also has aortic stenosis and calcifications <img src='img/arrows/WC.png'/>.*
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**Aortic Valve**
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*Double oblique CECT MIP shows dense calcifications of the aortic valve cusps <img src='img/arrows/WS.png'/> in a patient with severe aortic stenosis. Calcium burden correlates with severity of stenosis.*
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**Pericardial**
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*Axial NECT shows pericardial calcification <img src='img/arrows/WS.png'/> at the atrioventricular grooves. Note the epicardial fat <img src='img/arrows/WO.png'/> to differentiate from coronary calcium.*
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**Myocardial**
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*Left ventricular outflow view shows apical calcification <img src='img/arrows/WS.png'/> and wall thinning in a patient with prior myocardial infarction. Note the epicardial fat to differentiate from pericardium <img src='img/arrows/WO.png'/>. Wall motion abnormality was present (not shown).*
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**Neoplastic Mass**
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*Axial NECT (left) and bright blood MR (right) show a new calcification <img src='img/arrows/WS.png'/> in the RV of a 40-year-old patient with remote history of pulmonary embolus. This calcification corresponded to the presence of a chronic thrombus <img src='img/arrows/WO.png'/>.*
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**Neoplastic Mass**
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*Lateral radiograph shows curvilinear calcification <img src='img/arrows/WO.png'/> in the left atrium in a patient with left atrial myxoma.*
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### Additional Images
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**Mitral Valve Leaflets**
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*Four-chamber CECT shows both papillary muscle <img src='img/arrows/WS.png'/> and mitral valve annular <img src='img/arrows/WO.png'/> calcification. Papillary muscle calcification is commonly seen in dialysis patients.*
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