Cardiac Calcifications

Gregory Kicska, MD, PhD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Helpful Clues for Common Diagnoses

Coronary Artery
- Curvilinear, parallel lines most commonly in proximal coronary arteries and at vessel branch points
- Amount of calcium correlates with amount of coronary plaque but not degree of stenosis
- Presence correlates with risk of future cardiac events
Mitral Valve
- Annular calcifications: Associated with mitral valve insufficiency
- Valvular calcifications: Suggests stenosis, most often due to rheumatic heart disease
Aortic Valve
- Calcification burden correlates with stenosis severity
- Bicuspid valve: Young patient, coexistent coarctation
- Degenerative: > 60 years old, risk factor for coronary atherosclerosis
- Rheumatic heart disease: Coexistent mitral valve stenosis, > 35 years old

Helpful Clues for Less Common Diagnoses

Pericardial
- Associated with constrictive pericarditis
Myocardial
- Indicates prior infarction; myocardial fat will likely be present
Other Cardiac Valves and Chambers
- Tricuspid valve: Most commonly due to rheumatic heart disease, mitral and aortic valve will likely be calcified
- Pulmonary valve: Most commonly due to congenital pulmonary stenosis
- Atrial calcifications: Associated with severe atrial dilation

Helpful Clues for Rare Diagnoses

Mass
- Chronic thrombus: Atrial appendage or adjacent to infarcted myocardium
- Metastasis: History of primary tumor
- Atrial myxoma: Look for characteristic location and attachment