138 lines
9.5 KiB
Markdown
138 lines
9.5 KiB
Markdown
---
|
|
title: "Cardiac Calcifications"
|
|
docid: "c53ad786-4464-4a04-a3e9-ccd286e1f8fc"
|
|
authors:
|
|
- key: "df804626-c042-4296-96e3-836a6da50fd6"
|
|
value: "Gregory Kicska, MD, PhD"
|
|
breadcrumbs:
|
|
-
|
|
name: "Cardiac"
|
|
slug: "cardiac"
|
|
treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
|
|
-
|
|
name: "Differential Diagnosis"
|
|
slug: "differential-diagnosis"
|
|
treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
|
|
-
|
|
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
|
|
|
|
|
|
**Coronary Arteries**
|
|
*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'/>.*
|
|
|
|
|
|
**Coronary Arteries**
|
|
*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'/>.*
|
|
|
|
|
|
**Mitral Valve Leaflets**
|
|
*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.*
|
|
|
|
|
|
**Mitral Valve Leaflets**
|
|
*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'/>.*
|
|
|
|
|
|
**Aortic Valve**
|
|
*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.*
|
|
|
|
|
|
**Pericardial**
|
|
*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.*
|
|
|
|
|
|
**Myocardial**
|
|
*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).*
|
|
|
|
|
|
**Neoplastic Mass**
|
|
*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'/>.*
|
|
|
|
|
|
**Neoplastic Mass**
|
|
*Lateral radiograph shows curvilinear calcification <img src='img/arrows/WO.png'/> in the left atrium in a patient with left atrial myxoma.*
|
|
|
|
|
|
### Additional Images
|
|
|
|
|
|
**Mitral Valve Leaflets**
|
|
*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.*
|
|
|