An Unusual Finding During a Diagnostic Heart Catheterization

Abstract

A 73 year old man with a history of bradycardia with prior pacemaker implantation, mitral regurgitation with prior bioprosthetic mitral valve replacement, tricuspid valve repair, non-ischemic cardiomyopathy and recurrent pleural effusions was admitted from clinic due to worsening fatigue, abdominal distension, and leg swelling. Upon arrival, he was fluid overloaded on exam with markedly elevated B-type natriuretic peptide (3317 ng/dL). Acute decompensated heart failure was suspected and the patient was given intravenous furosemide. An echocardiogram was performed which revealed a newly declined ejection fraction of 20-24%, decreased from 30-35% previously. Given his decline in systolic function, a left heart catheterization was pursued to evaluate for new coronary ischemia. The left heart catheterization revealed obstructive distal vessel disease which was not significant enough to explain his cardiomyopathy. During the heart catheterization, the patient was incidentally noted to have a heavily calcified spleen (Figure 1A). To further evaluate this, a CT of the abdomen & pelvis were performed which revealed diffuse, stippled calcifications throughout the spleen (Figure 1B).