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Case Reports
. 2017 Jul 19:2017:bcr2017220368.
doi: 10.1136/bcr-2017-220368.

Abundant dystrophic calcifications mimicking aortic valve abscess in a patient undergoing elective aortic valve replacement

Adam L Booth  1 , Christine Q Li  1 , Ghannam Ayed Al-Dossari  1 , Heather L Stevenson  1
Affiliations
Case Reports

Abundant dystrophic calcifications mimicking aortic valve abscess in a patient undergoing elective aortic valve replacement

Adam L Booth et al. BMJ Case Rep. .

Abstract

Dystrophic calcifications of the aortic valve may cause symptomatic aortic stenosis and account for a significant portion of patients who undergo elective valve replacement. Calcifications appearing grossly as a cloudy fluid surrounding the aortic valve leaflets are an uncommon finding. Normally, calcified aortic valves are characterised by large, nodular masses within the aortic cusps. We report a case of dystrophic calcifications on a stenotic aortic valve encountered intraoperatively, which was suggestive of infective endocarditis and abscess formation. Aortic valve leaflets and necrotic-appearing thymic lymph node tissue were submitted for histology and special stains. Cultures were negative and histology did not show evidence of infection. Tissue histology demonstrated extensive dystrophic calcifications, which were polarised to reveal abundant calcium oxalate crystals. The benign nature of this unique pathological finding ruled out any suspicion of infection, avoiding a prolonged course of intravenous antibiotics in this patient.

Keywords: Cardiothoracic Surgery; Cardiovascular Medicine; Pathology; Valvar Diseases.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Tissue samples from our patient contained abundant dystrophic calcifications. The cloudy fluid obtained from the aortic valve was sent to microbiology. Panel A shows a representative example of the abundant calcium phosphate crystals that were observed in the smear made from this specimen. Panel B is a representative image from the atrophic thymus tissue, which showed focal areas of coagulative and fat necrosis, and did not contain any acute inflammation or other evidence of infection. Frequent calcium phosphate crystals were observed, and when the necrotic areas were polarised abundant calcium oxalate crystals were also present. The native aortic valve connective tissue did not show any evidence of infection, however also contained abundant calcifications (data not shown).
See this image and copyright information in PMC

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