1
|
Rafiee MJ, Bandegi P, Taylor JL. Extensive myocardial calcifications in a dialysis patient: A porcelain heart manifesting with abdominal pain. Radiol Case Rep 2024; 19:523-530. [PMID: 38044898 PMCID: PMC10686893 DOI: 10.1016/j.radcr.2023.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
This case report describes a 41-year-old male patient with chronic kidney disease on peritoneal dialysis presenting with upper abdominal pain and mild thigh numbness. CT chest demonstrated extensive myocardial calcifications and left atrial thrombus. This case emphasizes the clinical relevance of myocardial calcifications, especially in patients with end-stage renal disease. It also highlights the potential association between these calcifications and complications such as atrial fibrillation and thromboembolic events. The findings emphasize the need for diagnostic vigilance and an improved understanding of the pathophysiology of myocardial calcifications in the context of renal disease.
Collapse
Affiliation(s)
- Moezedin Javad Rafiee
- Department of Diagnostic Radiology, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
- Research Institute, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
| | - Pouya Bandegi
- Department of Diagnostic Radiology, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
| | - Jana Lyn Taylor
- Research Institute, McGill University Health Centre, 1001 Blvd Decarie, Montreal, Québec, H4A3J1 Canada
| |
Collapse
|
2
|
Myocardial calcification after orthotopic heart transplantation. J Heart Lung Transplant 2014; 33:219-21. [DOI: 10.1016/j.healun.2013.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/14/2013] [Accepted: 10/23/2013] [Indexed: 11/19/2022] Open
|
3
|
Takahashi H, Aoki T, Fukumoto Y, Sugimura K, Nochioka K, Miura Y, Tatebe S, Yamamoto S, Shibuya K, Shimokawa H. "Porcelain heart" a case of acute heart failure with massive myocardial calcification complicated with primary hyperparathyroidism. J Cardiol Cases 2013; 8:183-186. [PMID: 30534287 DOI: 10.1016/j.jccase.2013.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/22/2013] [Accepted: 08/12/2013] [Indexed: 11/17/2022] Open
Abstract
A 47-year-old Japanese woman was transported to our hospital due to acute heart failure (AHF). She had been diagnosed with primary hyperparathyroidism (pHPT) and undergone parathyroidectomy 3 months previously. Chest X-ray showed marked cardiomegaly and severe pulmonary congestion, and transthoracic echocardiography indicated both left ventricular (LV) systolic and diastolic dysfunction, complicated with extensive massive myocardial calcification and no LV hypertrophy. Computed tomography also showed massive myocardial calcification in the posterior wall of the LV and the interventricular septum. After treatment with furosemide, olprinone, and carperitide under Swan-Ganz monitoring, LV ejection fraction was almost normalized. However, cardiac catheterization in the chronic phase indicated that LV diastolic dysfunction still existed, which might be affected by myocardial calcification. We followed this patient using spironolactone (25 mg/day), perindopril (8 mg/day), and bisoprolol (1.25 mg/day), with no further episode of heart failure for at least 6 months. Here, we report a rare case of AHF complicated with massive myocardial calcification possibly caused by primary hyperparathyroidism. <Learning objective: This is the first case report of acute heart failure due to left ventricular systolic and diastolic dysfunction, complicated with massive myocardial calcification, "porcelain heart", possibly caused by primary hyperparathyroidism.>.
Collapse
Affiliation(s)
- Hidenori Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Tatsuo Aoki
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yoshihiro Fukumoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Yutaka Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Shunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Saori Yamamoto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| | - Kiyotaka Shibuya
- Department of Cardiology, Saka General Hospital, Shiogama, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
| |
Collapse
|
4
|
Matsui M, Okayama S, Takitsume A, Morimoto K, Samejima K, Uemura S, Saito Y. Heart Failure Associated with Metastatic Myocardial Calcification in a Hemodialysis Patient with Progressive Calcification of the Hand. Cardiorenal Med 2012; 2:251-255. [PMID: 23380932 DOI: 10.1159/000343497] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/14/2013] [Indexed: 11/19/2022] Open
Abstract
Metastatic myocardial calcification is a frequent cause of heart failure in hemodialysis patients. However, early detection is difficult, often resulting in a poor prognosis. A 47-year-old man with hemodialysis-dependent end-stage renal disease presented with progressive dyspnea. Levels of serum phosphate, calcium, and intact parathyroid hormone were poorly controlled. He developed pain in his right thumb 1 year before presentation, and the pain gradually increased and extended to the entire right hand. Hand radiography 1 month earlier had revealed significant progressive calcification. Echocardiography showed severe, diffuse hypokinesis and pericardial effusion as well as possible anterior myocardial calcification with high echogenicity. Chest computed tomography revealed a severely dilated heart with anterior massive myocardial calcification and a large amount of pericardial effusion, which was not detected on computed tomography performed 20 months earlier. The patient was diagnosed with heart failure associated with metastatic myocardial calcification and died suddenly 2 weeks later. This experience suggests that progressive metastatic calcification of the skin and subcutaneous tissue is useful for predicting myocardial calcification.
Collapse
Affiliation(s)
- Masaru Matsui
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | | | | | | | | | | | | |
Collapse
|
5
|
Lee WJ, Son CW, Yoon JC, Jo HS, Son JW, Park KH, Lee SH, Shin DG, Hong GR, Park JS, Kim YJ. Massive left atrial calcification associated with mitral valve replacement. J Cardiovasc Ultrasound 2010; 18:151-3. [PMID: 21253366 PMCID: PMC3021895 DOI: 10.4250/jcu.2010.18.4.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/20/2010] [Accepted: 08/23/2010] [Indexed: 12/15/2022] Open
Abstract
Calcification of the left atrium can be observed in patients with a long-lasting rheumatic heart disease. However, massive calcification of the atrial wall, so called porcelain or coconut atrium is very rare and has been generally reported only as incidental radiographic findings. We report a case of massive and firm calcifications at the left atrium in patient who underwent mitral valve replacement.
Collapse
Affiliation(s)
- Won Jae Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Shackley BS, Nguyen TP, Shivkumar K, Finn PJ, Fishbein MC. Idiopathic massive myocardial calcification: a case report and review of the literature. Cardiovasc Pathol 2010; 20:e79-83. [PMID: 20598909 DOI: 10.1016/j.carpath.2010.04.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 03/06/2010] [Accepted: 04/20/2010] [Indexed: 01/05/2023] Open
Abstract
We report a rare case of massive myocardial calcification in a 42-year-old male who presented with symptoms of congestive heart failure and arrhythmia. Myocardial calcification is most commonly associated with myocardial infarction or, less commonly, hypercalcemia. This case is particularly unusual due to the lack of any known predisposing risk factors, including normal coronary arteries, normal renal function, and normal serum calcium levels. Alternative etiologies are discussed accompanied by a review of the literature.
Collapse
Affiliation(s)
- Brit S Shackley
- Department of Pathology, UCLA David Geffen School of Medicine, Los Angeles, CA 90095-1732, USA.
| | | | | | | | | |
Collapse
|
7
|
Lahey T, Horton S. Massive left atrial calcification and devastating systemic emboli in a patient with chronic renal failure. Am J Kidney Dis 2002; 40:416-9. [PMID: 12148118 DOI: 10.1053/ajkd.2002.34547] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Valvular calcification is a common consequence of systemic calcium deposition resulting from chronic renal failure. Thrombi can form on such vascular calcifications and embolize to the cerebral, myocardial, and mesenteric vasculature with devastating consequences. We report the unique case of a patient with myocardial and cerebrovascular ischemia resulting from emboli arising from a massive mitral annular calcification.
Collapse
Affiliation(s)
- Timothy Lahey
- Department of Medicine, and LDS Hospital Echocardiography Laboratory, University of Utah, Salt Lake City, UT 84103, USA.
| | | |
Collapse
|