Home | | Radiology | Exercise: Heart And Great Vessel Calcifications

Chapter: Basic Radiology : Imaging of the Heart and Great Vessels

| Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail |

Exercise: Heart And Great Vessel Calcifications

Basic Radiology : Imaging of the Heart and Great Vessels : Exercise: Heart And Great Vessel Calcifications

EXERCISE 3-5. HEART AND GREAT VESSEL CALCIFICATIONS

3-21. In Case 3-21 (Figure 3-54) the calcific density (straight arrow( is due to calcification of the

 

A.         A,mitral valve

 

B.         B, tricuspid valve

 

C.         C, aorta valve

 

D.         D, pulmonary embolusy

 

E.         E, pericardium

 

3-22. In Case 3-22 (Figure 3-55) the calcification are related to

 

A, pulmonary arteries

B, pericardium

C, mycocardium

D, ascending aorta

.E, descending thoracic aorta


3-23. In Case 3-23 (Figure 3-56) the calcification on the chest radio graph are related to which structure?


            A,Pericardium

            B,Mitral valve

            C,Aortic valve

 

3-24. In Case 3-24 (Figure 3-57) the curved arrows point to calcification within the region of which cardiac structure?

 

A.  Aortic valve

 

B.Mitral valve

 

C.  Pericardium

 

D.    Coronary artery

 

E.Aortic aneurysm

 

3-25. In Case 3-25 (Figure 3-58) the arrows and arrow-heads point to a(n)

 

A.         calcified mediastinal mass.

 

B.         calcified left atrial myxoma.


C.         pulmonary embolus calcification.

 

D.         aortic valve calcification.

 

E.          mitral valve calcification.


Radiographic Findings

 

3-21. The PA and lateral chest radiographs (Figure 3-54) show curvilinear coarse calcifications in the mitral an-nulus (curve arrow) and linear calcification (straight arrow) reside in the aortic value, best seen on the lateral projection (C is the correct answer to Question 3-21).

 

3-22. This case (Figure 3-55) shows pericardial calcifica-tion in a woman who had viral pericarditis as a young child (B is the correct answer to Question 3-22). Note that the calcification is seen much better on the lat-eral view.

 

3-23. The chest radiograph in this case (Figure 3-56) shows linear calcification (arrows) in a focal area overlying the left ventricle. This calcification resides in a left ventricular aneurysm that this man developed after a myocardial infarction 6 years earlier (E is the correct answer to Question 3-23).

 

3-24. The lateral chest radiograph in this case (Figure 3-57) shows linear tram-track calcifications overlying the course of the coronary arteries. These calcifications represent coronary artery atherosclerosis in a patient with long-standing diabetes (D is the correct answer to Question 3-24).

 

3-25. In this case (Figure 3-58), a circular, heavily calcified area overlying the left atrium is seen in both the PA (arrowheads) and lateral (curved arrows) projec-tions. These calcifications resided within a left atrial myxoma that was causing the patient’s symptoms of shortness of breath and decreased exercise tolerance (B is the correct answer to Question 3-25).

 

Discussion

 

Calcifications, present in almost any area of the cardiovascu-lar system, may be either metastatic or dystrophic in origin. Metastatic calcifications are usually caused by soft-tissue deposition of calcium due to hypercalcemia of any cause. Dy-strophic soft-tissue calcifications are responses to tissue in-jury or degeneration and have no metabolic cause. They can be seen in practically any of the soft-tissue components of the cardiovascular system. We concentrate -ventional chest radiograph is within the aorta, usually in elderly patients with long-standing atherosclerotic disease or di-abetes. In this instance, the calcification is linear and is asso-ciated with the aortic wall. These calcifications may also be present in aneurysms (see Figure 3-34).


The aortic valve and mitral valve annulus are the most common intracardiac regions to demonstrate dystrophic cal-cification, usually secondary to long-standing stenosis or in-sufficiency from rheumatic fever. Bicuspid valves may also show this type of calcification. The lateral film is best for de-ciding which valve is calcified. A line drawn from the hilumobliquely and downward to intersect the anterior cardio-phrenic angle (N) will project behind aortic calcifications (A) (Figure 3-59). Calcifications that lie in back of this line are usually mitral annulus calcifications (M) (Figure 3-59). The presence of mitral annular calcification has been shown to predict the presence of carotid atherosclerosis and therefore may be associated with stroke.

Pericardial calcification as in Case 3-22 (Figure 3-55) is seen in approximately 50% of patients with constrictive peri-carditis. It has a characteristic curvilinear appearance outlin-ing the location of the pericardium and is most often seen along the right heart border (Figure 3-55).

 

Myocardial calcification, as is seen in left ventricular aneurysms, was discussed in the exercise on altered cardiac contour and is shown in a slightly different form in Case 3-23 (Figure 3-56). Thin, focal, linear calcifications overlying the left ventricle should be considered as aneurysms, and echocardiography, CT, and MR imaging are all useful exami-nations to confirm this diagnosis.

 

Calcifications within the wall of the coronary arteries, as exhibited in Case 3-24 (Figure 3-57), are recognized on con-ventional radiographs as thin, linear, calcific deposits corre-sponding to the course of the coronary arteries. When discovered by conventional radiographs, it is a late finding of atherosclerosis, and these patients have a high incidence of obstructive coronary artery disease.

 

Case 3-25 (Figure 3-58) is an example of the rare pri-mary cardiac neoplasm that may calcify and be detected ini-tially on the plain film. The cardiac tumor that most commonly calcifies is the left atrial myxoma, and calcifica-tion occurs in about 10% of these lesions (Figure 3-58). Rarely, myocardial metastatic disease (such as osteosar-coma) or other primary cardiac tumors may calcify. Finally, primary mediastinal neoplasms such as teratomas may rarely show calcification. In these patients, CT should be performed for diagnosis.


Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail


Copyright © 2018-2020 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.