Aortic sinus of Valsalva calcification: a roentgen sign on the lateral chest film.

Abstract

The aortic walls of the sinuses of Valsalva, when calcified, have a distinctive appearance on the lateral chest radiograph. Our search for this calcification was initiated by the case illustrated in Figure 1. The calcified origin of the left coronary artery identified the posterior sinus wall. The anterior sinus wall was identified by projecting the anterior wall of the ascending aorta into the base of the heart. During routine film readings over a nine-month period, 9 cases of calcified sinus of Valsalva walls were observed. The anterior wall was calcified alone in 6 cases, and in association with the posterior wall in the other 3. If both walls seen in tangent are calcified, a picture resembling parentheses is formed, whereas when only the anterior is involved, a comma-like figure is formed. The noncoronary sinus wall is not seen in tangent, and cannot be identified. Proof of the location of the calcification was obtained at postmortem in one patient. In two others, calcification at the origin of a coronary artery definitely established the site of the sinus wall. Cinefluoroscopic studies were performed in 4 patients, and the calcification was easily seen in the lateral position. Its motion conformed to that of the ascending aorta. Only one patient exhibited associated roentgeno-graphically identifiable aortic valvular calcification. Clinical Data The ages of our patients ranged from sixty-three to one hundred and two years, with an average of eighty-one. Eight of the 9 were women. All 9 had a negative history for lues and a negative serology, but, in the only male in the group, the additional finding of a dilated, calcified ascending aorta suggested luetic aortitis. Five patients had either suggestive or definite findings of aortic stenosis. In one of the latter, autopsy revealed a calcified aortic valve which had not been seen roentgenographically. Comment The radiologic literature refers to calcified sinus of Valsalva walls only in connection with luetic aortitis and sinus of Valsalva aneurysm (1–3). Jorgens et al. did not include sinus of Valsalva calcification in his classification of cardiac calcifications seen during cinefluoroscopic examination (2). Our recent experience, however, suggests that aortic sinus wall calcification is relatively common in the geriatric population. The finding of clinical aortic stenosis in 2 of our patients and its possible presence in 3 others may be significant. Review of the pathologic literature dealing with nonrheumatic calcific aortic stenosis confirms its frequent association with aortic sinus wall calcification (4–6). In fact, some authors believe that heavy confluent calcification in the sinus wall is an integral part of the valvular calcification (5).