---
title: "Cardiac Calcifications"
docid: "c53ad786-4464-4a04-a3e9-ccd286e1f8fc"
authors:
- key: "df804626-c042-4296-96e3-836a6da50fd6"
value: "Gregory Kicska, MD, PhD"
breadcrumbs:
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name: "Cardiac"
slug: "cardiac"
treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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name: "Differential Diagnosis"
slug: "differential-diagnosis"
treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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name: "Cardiac Calcifications"
slug: "cardiac-calcifications"
treeNodeId: null
category: "Cardiac"
documentVersionId: "76a1cfbf-a803-4de9-be9e-02798943ac36"
imageCount: 9
lastUpdated: "03/17/22"
pageDescription: "Cardiac Calcifications"
pageKeywords: "Cardiac, Differential Diagnosis, Cardiac Calcifications"
pageTitle: "Cardiac Calcifications | STATdx"
enhancedTitle: "Cardiac Calcifications"
type: "DDX"
breadcrumbs:
- "Cardiac"
- "Differential Diagnosis"
- "Cardiac Calcifications"
---
# ESSENTIAL INFORMATION
- ## Key Differential Diagnosis Issues
- Most common pitfall is misidentifying which anatomic structure is calcified
- Cardiac calcifications more common in dialysis patients
- ## Helpful Clues for Common Diagnoses
- **Coronary Artery**
- Curvilinear, parallel lines most commonly in proximal coronary arteries and at vessel branch points
- Amount of calcium correlates with amount of coronary plaque but not degree of stenosis
- Presence correlates with risk of future cardiac events
- **Mitral Valve**
- Annular calcifications
- Associated with mitral valve insufficiency
- Valvular calcifications
- Suggests stenosis, most often due to rheumatic heart disease
- **Aortic Valve**
- Calcification burden correlates with stenosis severity
- Bicuspid valve
- Young patients
- Coexistent coarctation
- Degenerative
- Patients > 60 years of age
- Risk factor for coronary atherosclerosis
- Rheumatic heart disease
- Patients > 35 years of age
- Coexistent mitral valve stenosis
- ## Helpful Clues for Less Common Diagnoses
- **Pericardial**
- Associated with constrictive pericarditis
- **Myocardial**
- Indicates prior infarction; myocardial fat will likely be present
- **Other Cardiac Valves and Chambers**
- Tricuspid valve
- Most commonly due to rheumatic heart disease; mitral and aortic valve will likely be calcified
- Pulmonary valve
- Most commonly due to congenital pulmonary stenosis
- Atrial calcifications
- Associated with severe atrial dilation
- ## Helpful Clues for Rare Diagnoses
- **Mass**
- Chronic thrombus
- Atrial appendage or adjacent to infarcted myocardium
- Metastasis
- History of primary tumor
- Atrial myxoma
- Look for characteristic location and attachment
## Images
### Selected Images
in a patient with LAD atherosclerosis. Note the presence of noncalcified plaque 
.](images/app.statdx.com_image_thumbnail_db03a28e-2ac9-4d31-9d54-369bb04c906e_annotated_true_size_900_quality_90_c88bbdcd97e4d15c05c6c4d6a29b4ebb91c7bb34.jpg)
**Coronary Arteries**
*Axial oblique CECT MIP shows discrete calcifications in a linear arrangement in a patient with LAD atherosclerosis. Note the presence of noncalcified plaque .*
**Coronary Arteries**
*Axial oblique CECT MIP shows discrete calcifications in a linear arrangement in a patient with LAD atherosclerosis. Note the presence of noncalcified plaque .*
indicating mitral valve annular calcification. This calcification pattern is very common and, unlike leaflet calcification, not usually associated with stenosis.](images/app.statdx.com_image_thumbnail_c38155fa-ebff-40f3-8cba-e54e6cacf762_annotated_true_size_900_quality_90_feafbe2ae7b5c490a93f435825ed186ee9877466.jpg)
**Mitral Valve Leaflets**
*Frontal radiograph shows characteristic reversed C-shaped calcification indicating mitral valve annular calcification. This calcification pattern is very common and, unlike leaflet calcification, not usually associated with stenosis.*
.](images/app.statdx.com_image_thumbnail_ac0da574-c315-45f0-9846-cf3e16700193_annotated_true_size_900_quality_90_0fe8d8cac6b4c1d8f4754d7f402b67d520d274c4.jpg)
**Mitral Valve Leaflets**
*Axial NECT shows mitral valve leaflet calcifications in a patient with mitral stenosis presumed to be due to rheumatic heart disease. Note the enlarged left atrium and left atrial calcifications . The patient also has aortic stenosis and calcifications .*
**Aortic Valve**
*Double oblique CECT MIP shows dense calcifications of the aortic valve cusps in a patient with severe aortic stenosis. Calcium burden correlates with severity of stenosis.*
**Pericardial**
*Axial NECT shows pericardial calcification at the atrioventricular grooves. Note the epicardial fat to differentiate from coronary calcium.*
**Myocardial**
*Left ventricular outflow view shows apical calcification and wall thinning in a patient with prior myocardial infarction. Note the epicardial fat to differentiate from pericardium . Wall motion abnormality was present (not shown).*
**Neoplastic Mass**
*Axial NECT (left) and bright blood MR (right) show a new calcification 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 .*
**Neoplastic Mass**
*Lateral radiograph shows curvilinear calcification in the left atrium in a patient with left atrial myxoma.*
### Additional Images
**Mitral Valve Leaflets**
*Four-chamber CECT shows both papillary muscle and mitral valve annular calcification. Papillary muscle calcification is commonly seen in dialysis patients.*