Rapid Progression of Pericardial Calcification Containing a “Calcium Paste” in a Patient With End-Stage Renal Disease

Abstract

A 52-year-old man with end-stage renal disease (ESRD) secondary to chronic glomerulonephritis was admitted to our hospital with aggravated exertional dyspnea. He had been maintained on hemodialysis for the past 16 years. One year previously, he had been hospitalized for complicated pleural effusion, which was confirmed as Gram-positive cocci infection, and was treated through percutaneous drainage and antibiotics. Chest computed tomography (CT) taken at the time of initial hospitalization showed bilateral complicated pleural effusion and diffuse pericardial thickening without calcification (Figure 1). During that period, parathyroid hormone markedly increased to 1113 pg/mL (normal range, 10 to 65 pg/mL); hyperphosphatemia was also noted. His hyperparathyroidism was thought to be secondary to ESRD; thus, he underwent subtotal parathyroidectomy 6 months later. Serial plain chest radiographs at the time of pleural infection and at the time of parathyroidectomy showed rapid progression of the smooth and diffuse pericardial calcific opacities within only a 6-month period, and these findings were maintained until this admission (Figure 2). Transthoracic echocardiography revealed diffuse pericardial thickening with septal bouncing and inferior vena cava plethora, suggestive …