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. 2020 Nov 8;4(6):1-5.
doi: 10.1093/ehjcr/ytaa283. eCollection 2020 Dec.

Case report: Metastatic cardiac calcifications in a patient with a history of rickets

Matias Lopez Avecilla  1 , Mariana Corneli  1 , Gisela Killinger  1 , Carlos Rodriguez Correa  1
Affiliations

Case report: Metastatic cardiac calcifications in a patient with a history of rickets

Matias Lopez Avecilla et al. Eur Heart J Case Rep. .

Abstract

Background: Metastatic cardiac calcifications are often seen in patients with renal failure and dialysis associated with vascular calcification and calcifications in other organs. There is little to no evidence of metastatic cardiac calcification in patients with a history of rickets.

Case summary: A 40-year-old patient with a history of rickets treated in infancy and no personal history of cardiovascular or renal disease came for a periodical examination. Transthoracic echocardiogram showed an important calcification in the mitral annulus and the mitro-aortic junction. Computed tomography (CT) showed marked calcification affecting the heart fibrous skeleton. Coronary arteries were not affected.

Discussion: Distribution of heart calcification seen both with echocardiography and CT is important to report so they can be identified as dystrophic or metastatic. These two have different aetiologies so the description may help identify the possible cause.

Keywords: Computed tomography; Case report; Echocardiography; Metastatic cardiac calcification; Mitro-aortic junction; Rickets.

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Figures

Figure 1
Figure 1
12-Lead electrocardiogram (EKG).
Figure 2
Figure 2
Two-dimensional transthoracic echocardiogram. (A) Long parasternal view showing the calcification of the mitro-aortic junction, involving the aortic valve and aortic root. (B) Minimal mitral regurgitation with the jet directed towards the posterior atrial wall. (C) Parasternal short-axis view exhibiting the calcification of the heart’s fibrous skeleton along the fibrous trigonous. (D) Apical four chamber off-axis view showing calcifications within the atrioventricular groove and the mitral annulus.
Figure 3
Figure 3
Multiplanar reconstruction of cardiac computed tomography scan. Short-axis view of the mitral annulus showing the mass calcification of the heart’s fibrous skeleton, mitral annulus and the atrioventricular groove. (A) Non-contrast CT. (B) Gated contrast computed tomography. (C) Volume-rendered. AL, anterior mitral leaflet; AV, aortic valve; MAJ, mitro-aortic junction; PL, posterior mitral leaflet; PV, pulmonary valve.
Figure 4
Figure 4
Contrast cardiac computed tomography showing calcification of aortic-mitral continuity. (A) Three chamber view. (B) Short-axis cross-section view at the left ventricular outflow tract. (C) Short-axis cross-section view of the aortic valve. AV, aortic valve; LA, left atrium; LVOT, left ventricular outflow tract; LV, left ventricle: MAJ, mitro-aortic junction.
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