An Unusual Case of Extensive Intra-Thoracic and Intra Abdominal Calcifications

Attila Frigy,Ildiko Kocsis

doi:10.21767/2471-8041.100085

Abstract

The paper presents a rare case of massive visceral calcifications in a patient with congestive heart failure caused by effusive-constrictive pericarditis. The thoracic and abdominal CT demonstrated extensive visceral calcifications, including huge, shell-like perirenal calcified masses. Highly elevated parathormone levels revealed the diagnosis of a long lasting hyperparathyroidism as substrate for our findings.

Highlights

In the daily practice the clinician frequently meet common cases, like those with heart failure, having the risk to fall in the routine approach of management, but sometimes – like in our case–a good spirit of observation, combined with modern imaging techniques could reveal rare and impressive substrates of the clinical situation
A 73-year-old man was referred to our clinic with the diagnosis of congestive heart failure, the main reason for admission being generalized edema, right pleural effusion and ascites
Transthoracic echocardiography revealed the presence of an effusive-constrictive pericarditis as substrate of heart failure

Summary

Introduction

In the daily practice the clinician frequently meet common cases, like those with heart failure, having the risk to fall in the routine approach of management, but sometimes – like in our case–a good spirit of observation, combined with modern imaging techniques could reveal rare and impressive substrates of the clinical situation. Transthoracic echocardiography revealed the presence of an effusive-constrictive pericarditis as substrate of heart failure. The typical pattern of cardiac remodeling, evidence of interdependence of ventricular filling and the presence of a thickened pericardium with effusion (with a maximum diameter of 9 mm), containing fibrin deposits, was diagnostic in this regard (Panel A). Computer tomography revealed unusually massive intra-thoracic (including pericardial) and intra-abdominal, superficial, and deep, intra- and retroperitoneal, calcified masses (Panel B and C with arrows). The most spectacular were the “shells” accompanying the two kidneys (Panel D with arrows). Panel A - Pericardial thickening and effusion on echocardiography (parasternal long axis view). Panel B - Intra-thoracic (arrow) and pericardial calcifications. Panel C - Superficial and profound (arrows) intraperitoneal calcifications. Panel D - Massive retroperitoneal calcifications with shelllike appearance accompanying the two kidneys (arrows)

Discussion

Conclusion