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Ramirez-Suarez KI, Cohen SA, Barrera CA, Levine MA, Goldberg DJ, Otero HJ. Longitudinal assessment of vascular calcification in generalized arterial calcification of infancy. Pediatr Radiol 2022; 52:2329-2341. [PMID: 35438330 PMCID: PMC10406615 DOI: 10.1007/s00247-022-05364-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Generalized arterial calcification of infancy (GACI), also known as idiopathic infantile arterial calcification, is a very uncommon genetic disorder characterized by calcifications and stenoses of large- and medium-size arteries that can lead to end-organ damage. OBJECTIVE To describe changes in imaging findings in 10 children with GACI at a single institution from 2010 to 2021. MATERIALS AND METHODS In this retrospective study we reviewed initial and follow-up body imaging in children with genetic confirmation of GACI at our hospital. All initial images were analyzed for the presence and distribution of arterial calcifications, stenoses and wall thickening/irregularity within the chest, abdomen and pelvis. We compared available follow-up studies to the initial imaging findings. We extracted clinical information including prenatal and postnatal treatment from the children's medical records. RESULTS We evaluated 10 children (five boys) with a diagnosis of GACI. Median age at first body imaging was 8 days (range: 1 day to 5 years). Six children were identified prenatally and four postnatally. Postnatal presentation included cardiac failure, seizures and hypertension. Images in newborns (n = 8) most commonly showed diffuse arterial calcifications (6/8; 75%), while stenoses were less common (2/8; 25%) during this period. Two children were diagnosed after the neonatal period - one in infancy and one during childhood. In total, half the children (5/10; 50%) had arterial stenoses - three cases visualized at first imaging and two identified on follow-up images during infancy. Stenoses had completely resolved in one child (1/5; 20%) at last follow-up. Eight children received prenatal or postnatal treatment or both. All children who received both prenatal and postnatal treatment (n = 4) had completely resolved calcifications at last follow-up. CONCLUSION Children with GACI might have characteristic vascular calcifications at birth that raise the suspicion of this disease. Arterial calcifications decrease or disappear spontaneously or after treatment, but arterial stenoses usually persist. Calcifications and arterial stenoses can be easily identified and followed with non-contrast CT and CT angiography.
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Affiliation(s)
- Karen I Ramirez-Suarez
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Sara A Cohen
- Department of Radiology at Weill Cornell Medicine, New York, NY, USA
| | - Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Center for Bone Health, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J Goldberg
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Idiopathic infantile arterial calcification: a case report of successful extracorporeal membrane oxygenation support. Int J Artif Organs 2017; 39:575-579. [PMID: 28085170 DOI: 10.5301/ijao.5000544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2016] [Indexed: 11/20/2022]
Abstract
Idiopathic infantile arterial calcification is a rare cause of infantile ischemic cardiac failure with extremely poor prognosis. We present the first case report of successful extracorporeal membrane oxygenation support and outcome in a child with idiopathic infantile arterial calcification (IIAC). This 6-week-old infant presented with cardiogenic shock and circulatory collapse. The patient underwent extracorporeal cardiopulmonary resuscitation, allowing stabilization, diagnosis, and treatment with etidronate, followed by successful discharge to home.
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Pala HG, Bilgili G, Artunc Ulkumen B, Alkan F, Coskun S. A case of antenatal diagnosis and postnatal characteristics of ıdiopathic ınfantile arterial calcification (IIAC and prenatal diagnosis). J OBSTET GYNAECOL 2016; 36:665-7. [PMID: 27019311 DOI: 10.3109/01443615.2015.1133577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | - Fatos Alkan
- c Pediatrics Department Pediatric Cardiology Division , Celal Bayar University School of Medicine , Manisa , Turkey
| | - Senol Coskun
- c Pediatrics Department Pediatric Cardiology Division , Celal Bayar University School of Medicine , Manisa , Turkey
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Bolster F, Ali Z, Southall P, Fowler D. Generalized arterial calcification of infancy—Findings at post-mortem computed tomography and autopsy. Forensic Sci Int 2015; 254:e7-12. [DOI: 10.1016/j.forsciint.2015.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 11/15/2022]
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Mastrolia SA, Weintraub AY, Baron J, Sciaky-Tamir Y, Koifman A, Loverro G, Hershkovitz R. Antenatal diagnosis of idiopathic arterial calcification: a systematic review with a report of two cases. Arch Gynecol Obstet 2014; 291:977-86. [DOI: 10.1007/s00404-014-3567-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
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Generalized Arterial Calcification of Infancy: Fatal Clinical Course Associated with a Novel Mutation in ENPP1. JIMD Rep 2011; 1:23-7. [PMID: 23430823 DOI: 10.1007/8904_2011_11] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 12/12/2010] [Accepted: 12/15/2010] [Indexed: 12/13/2022] Open
Abstract
Generalized arterial calcification of infancy (GACI) is a rare condition characterized by arterial calcification within the internal elastic lamina associated with intimal proliferation, leading to stenosis of great and medium-sized vessels. This disease, caused by mutations in multiple exons of ENPP1, frequently results in death in infancy. Nowadays, the most promising therapeutic compounds for this rare disease are bisphosphonates. We describe a case of GACI associated with the novel mutation c.653A>T (p.D218V) in ENPP1 on both alleles. The male infant was delivered prematurely and developed heart failure, severe hypertension, and diffuse calcifications of all arterial districts. He was treated with etidronate (18 mg/kg/day); however, the clinical condition did not improve, and a resolution of calcifications was not observed. The infant died within the 6th month of life of ischemic heart failure. We conclude that even if the diagnosis of GACI is established early and bisphosphonate treatment is started early, the prognosis can be very poor.
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Agapitou P, Lazaris AC, Agapitos E, Patsouris ES. Abruptio placentae and idiopathic arterial calcification in a stillborn. J Matern Fetal Neonatal Med 2006; 19:583-5. [PMID: 16966129 DOI: 10.1080/14767050600736457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We report a case of idiopathic arterial calcification in a stillborn of 22 weeks gestational age. The pregnancy was complicated by abruptio placentae and the postmortem examination showed widespread arterial calcification in the placenta, as well as in the pulmonary, renal, cerebellar, and brain arteries.
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Affiliation(s)
- Pagona Agapitou
- Department of Pathology, School of Medicine, First National and Kapodistrian University of Athens, Athens, Greece
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Glatz AC, Pawel BR, Hsu DT, Weinberg P, Chrisant MRK. Idiopathic infantile arterial calcification: two case reports, a review of the literature and a role for cardiac transplantation. Pediatr Transplant 2006; 10:225-33. [PMID: 16573612 DOI: 10.1111/j.1399-3046.2005.00414.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Idiopathic infantile arterial calcification (IIAC) is a rare, but important, cause of rapidly progressive ischemic heart disease in children. In this paper, we report two recent cases of IIAC seen at tertiary referral hospitals. Both cases presented in infancy with signs of heart failure and, ultimately, died with the diagnosis of IIAC confirmed at postmortem examination. A thorough review of the literature reveals approximately 160 reported cases of IIAC. The clinical outcomes, radiographic findings and pathologic details are summarized. Proposed etiologic mechanisms are reviewed, including promising research into the role of inorganic pyrophosphate as a regulatory factor in the development of IIAC. Because of the typically fatal outcome of IIAC and the lack of proven therapies, the potential role for cardiac transplantation is discussed.
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Affiliation(s)
- Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Tran KH, Boechat MI. Idiopathic infantile arterial calcification: imaging evaluation and the usefulness of MR angiography. Pediatr Radiol 2006; 36:247-53. [PMID: 16429273 DOI: 10.1007/s00247-005-0044-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 09/19/2005] [Accepted: 09/29/2005] [Indexed: 10/25/2022]
Abstract
Idiopathic infantile arterial calcification (IIAC) is a rare condition characterized by extensive calcification and stenosis of large and medium-size arteries. The etiology of the disease is unknown. However, the inheritance pattern has been shown to be autosomal recessive. The clinical presentation is variable, including cardiac failure (most common clinical finding), hypertension, and respiratory failure. Plain radiography, sonography and MRI can aid in the diagnosis. We present a case in which contrast-enhanced MR angiography with breath-hold and cardiac gating techniques allowed complete evaluation of the extent of this disease.
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Affiliation(s)
- Kim H Tran
- Department of Radiological Sciences, Pediatric Radiology, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, Box 951721, Los Angeles, CA 90095-1721, USA
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Greenberg SB, Gibson J. New Findings in Idiopathic Arterial Calcification of Infancy Detected by MDCT. AJR Am J Roentgenol 2005; 185:530-2. [PMID: 16037532 DOI: 10.2214/ajr.185.2.01850530] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- S Bruce Greenberg
- Department of Radiology, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 800 Marshall St., Little Rock, AR 72202, USA.
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Cheng KS, Chen MR, Ruf N, Lin SP, Rutsch F. Generalized arterial calcification of infancy: Different clinical courses in two affected siblings. Am J Med Genet A 2005; 136:210-3. [PMID: 15940697 DOI: 10.1002/ajmg.a.30800] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Generalized arterial calcification of infancy (GACI) is a rare autosomal recessive disease caused by mutations in ENPP1. Due to extensive calcification of the arterial media associated with intimal proliferation leading to vascular occlusion, most affected children die within the first 6 months of life. We report on two Taiwanese siblings with an identical genotype, but different clinical course. The male sibling developed heart failure and severe hypertension, and died at the age of 6 weeks despite of treatment with bisphosphonates, ACE inhibitors, and hydralazine. The subsequent female, who was monitored closely pre- and post-natally, is having an uncomplicated clinical course up to the age of 1(1/2) year now. There were similar characteristic sonographic and roentgenographic findings in both siblings in early infancy. In both siblings, the same compound heterozygous mutations (c.1025G > T [p.Gly342Val] and c.1112A > T [Tyr371Phe]) in ENPP1 were identified. Despite the same genotype and similar sonographic and radiographic features in early infancy, the phenotype of GACI can vary to a great extent within one family.
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Affiliation(s)
- Kun-Shan Cheng
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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Whitehall J, Smith M, Altamirano L. Idiopathic infantile arterial calcification: sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2003; 31:497-501. [PMID: 14595743 DOI: 10.1002/jcu.10208] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Idiopathic infantile arterial calcification (IIAC) is a rare disease that is characterized by calcification in the media and fibroproliferative changes in the intima of larger arteries, sometimes resulting in reduced vascular elasticity and blood flow. Although the molecular-genetic basis of the disease is unknown, IIAC is presumed to be acquired by an autosomal recessive mode of inheritance and is associated with a reduction in the levels of enzymes responsible for inorganic phosphate balance, resulting in abnormal deposition of calcium into the vessels. We report the case of a female neonate in whom widespread IIAC was initially diagnosed on postnatal sonographic examination. At birth, the infant experienced cardiac failure and hypertension, and arterial pulsation was absent. Routine prenatal sonographic examinations had not revealed any abnormalities, but postnatal gray-scale and color Doppler echocardiographic and sonographic examinations revealed findings consistent with severe IIAC. The cardiac function improved with treatment, but the neonate died of progressive hepatic failure due to reduced flow in calcified and narrowed hepatic arteries. The common carotid arteries were also grossly affected, resulting in cerebral atrophy at the time of birth. Postnatal gray-scale and color Doppler echocardiographic and sonographic examinations allowed noninvasive diagnosis, assessment of severity, and monitoring of progression.
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Affiliation(s)
- John Whitehall
- Department of Neonatology, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Queensland 4814, Australia
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Nagar AM, Hanchate V, Tandon A, Thakkar H, Chaubal NG. Antenatal detection of idiopathic arterial calcification with hydrops fetalis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2003; 22:653-659. [PMID: 12795564 DOI: 10.7863/jum.2003.22.6.653] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Idiopathic arterial calcification of infancy, or occlusive infantile arterial calcification, is a rare cause of arterial calcification. This condition is inherited as an autosomal recessive pattern, which is almost always fatal. In most of the 100 cases described in the literature, the diagnosis was made at autopsy; a few cases have been reported in which an antemortem diagnosis was made on the basis of radiographic or sonographic demonstration of arterial calcification. The clinical characteristics are extremely variable, and respiratory distress with cardiac failure is the most common finding. Hypertension that is refractory to treatment is present in most cases. Most infants die before the age of 6 months, and very few have survived for more than 1 year. Mortality in this condition is caused by myocardial ischemia due to coronary artery involvement or refractory cardiac failure. The purpose of this report is to describe the prenatal diagnosis of idiopathic arterial calcification. Fewer than 10 cases of antenatal detection of this condition have been reported in the literature. This case is 1 of 2 cases with the earliest diagnosis of this condition so far (Table 1).
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Affiliation(s)
- Arpit M Nagar
- Department of Radiology, King Edward Memorial Hospital, Parel, Mumbai 400012, India.
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Sebire NJ, Ramsay A, Sheppard M. Idiopathic arterial calcification presenting with cardiac failure and sudden death in an 11-year-old girl. Pediatr Dev Pathol 2002; 5:412-4. [PMID: 12016527 DOI: 10.1007/s10024-001-0256-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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