Incidental findings of pericardial calcification

Abstract

Calcification of the pericardium is a relatively rare finding and often has an uncertain etiology. Incidental findings of pericardial calcification may increase due to widespread application of cardiac computed tomography for the assessment of coronary atherosclerosis in the appropriate clinical setting using coronary artery calcium scoring and/or coronary angiography. Pericardial calcification alone is asymptomatic and is neither necessary nor sufficient for the diagnosis of pericardial constriction. Its presence may suggest of diffused pericardial scarring and consequently, its pathological involvement with pericardial constriction. Calcification of the pericardium must be evaluated with full clinical knowledge to facilitate an accurate diagnosis and an appropriate therapy when required. Our objective is to present a case of asymptomatic pericardial calcification and to discuss the importance of its clinical implications.

Keywords: Cardiac computed tomography; Constrictive pericarditis; Pericardial calcification.

Figure 1

Electrocardiogram showed sinus bradycardia with a heart rate of 59 bpm and RSR’ in V1.

Figure 2

Non-contrast cardiac computed tomography for coronary artery calcium scoring showed moderate pericardial calcification mostly involving anterior (A) and inferobasal (B) portion of the pericardium.

Figure 3

Apical four chamber view of transthoracic echocardiogram and pulse wave Doppler’s recording. A: Tricuspid valve inflow in a patient with constrictive pericarditis; B: Mitral valve inflow in a patient with constrictive pericarditis. Note with inspiration, the E-wave velocity of mitral valve inflow decreases significantly. This reflects the hemodynamic changes in constrictive pericarditis, resulting from the lack of intrathoracic pressure transmission to the cardiac chambers and the exaggerated ventricular interdependence.