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Yagi-Nakajima S, Miura M, Sawada S, Funaki T, Uchimura K, Susukita K, Hatakeyama T, Kagaya Y, Saito H, Sato K, Kanazawa M, Kondo M, Endo H, Yaegashi H, Nakamura A. An Autopsy Case of Fulminant Myocarditis with Massive Left Ventricular Calcification. Intern Med 2024; 63:821-827. [PMID: 38494729 PMCID: PMC11008995 DOI: 10.2169/internalmedicine.2200-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/04/2023] [Indexed: 03/19/2024] Open
Abstract
Myocardial calcification in myocarditis is rare and may be linked to poor outcomes. We herein report a case of fulminant myocarditis with massive myocardial calcification and its pathological outcomes at autopsy. A 49-year-old man experienced chest pain and was diagnosed with acute myocarditis. His cardiac function did not recover despite mechanical circulatory support in combination with V-A extracorporeal membrane oxygenation and IMPELLA CP®. He eventually developed sepsis and gastrointestinal bleeding and died on day 27. Diffuse myocardial calcification was observed on computed tomography at autopsy. The pathological autopsy depicted that calcification filled every myocardial cell in the left ventricle.
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Affiliation(s)
| | - Masanobu Miura
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Shun Sawada
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Takahiro Funaki
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Kumi Uchimura
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Kai Susukita
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | | | - Yuta Kagaya
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Hiroki Saito
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Kenjiro Sato
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | | | - Masateru Kondo
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Hideaki Endo
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
| | - Hiroshi Yaegashi
- Department of Pathology, Iwate Prefectural Central Hospital, Japan
| | - Akihiro Nakamura
- Department of Cardiology, Iwate Prefectural Central Hospital, Japan
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Lesjak V, Pirnat M. Diffuse Myocardial Calcifications Caused by Leptospirosis. Cureus 2023; 15:e45345. [PMID: 37849598 PMCID: PMC10577803 DOI: 10.7759/cureus.45345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/19/2023] Open
Abstract
Severe leptospirosis is defined by multiple organ failure. Cardiac involvement is an uncommon complication in patients with leptospirosis, and the pathophysiology of it is not well understood. Diffuse myocardial calcifications connected with sepsis are infrequent, and their effect on heart function is hard to predict. They can lead to conduction disorders and arrhythmias, thereby causing sudden death. Myocardial calcifications are usually revealed incidentally by radiological investigations such as computed tomography (CT) scan in patients with or after sepsis and are commonly unidentified in practice because most cases progress gradually. This case report involves a 51-year-old male who presented to the emergency department with sepsis. The patient was diagnosed with leptospirosis, causing septic cardiomyopathy and diffuse calcifications of the myocardium of the left ventricle. This case highlights the importance of multimodality imaging and a multidisciplinary approach to diagnoses since early recognition and treatment are essential. Follow-up of such patients is necessary to monitor the systolic function of the left ventricle and cardiac arrhythmia.
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Affiliation(s)
- Vesna Lesjak
- Radiology, University Medical Centre Maribor, Maribor, SVN
| | - Maja Pirnat
- Radiology, University Medical Centre Maribor, Maribor, SVN
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Garcia-Cardenas M, Jimenez-Santos M, Cabello-Ganem A, Solorzano-Pinot E, Serrano-Roman J, Fernandez-Badillo V, Espejel-Guzman A, Aparicio-Ortiz AD, Canseco-Leon N, Espinola-Zavaleta N. Single-Photon Emission Computed Tomography Assessment of Sepsis-Related Myocardial Calcification. Heart Lung Circ 2023; 32:e19-e20. [PMID: 36813593 DOI: 10.1016/j.hlc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/03/2023] [Accepted: 01/15/2023] [Indexed: 02/22/2023]
Affiliation(s)
- Mauricio Garcia-Cardenas
- Department of Cardiac Computed Tomography, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Moises Jimenez-Santos
- Department of Cardiac Computed Tomography, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Enrique Solorzano-Pinot
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Javier Serrano-Roman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Valente Fernandez-Badillo
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Adrian Espejel-Guzman
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | - Nadia Canseco-Leon
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico; Department of Echocardiography, ABC Medical Center IAP, Mexico City, Mexico.
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Yoshihara S, Yaegashi T, Matsunaga M, Naito M. Rapidly progressive myocardial calcification following sepsis. J Cardiol Cases 2022; 25:166-169. [DOI: 10.1016/j.jccase.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/25/2022] Open
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Li J, Chelala L, Hossain R, Jeudy J, White C. Rapid Onset Development of Myocardial Calcifications in the Setting of Renal Failure and Sepsis. Radiol Cardiothorac Imaging 2021; 3:e200549. [PMID: 33969311 DOI: 10.1148/ryct.2021200549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/27/2020] [Accepted: 01/13/2021] [Indexed: 11/11/2022]
Abstract
Myocardial calcifications can arise following damage to myocardial tissue or in the setting of disturbances in the calcium and phosphorus balance. They are associated with a number of cardiac sequelae, as well as higher mortality. Three cases of rapid-onset myocardial calcifications that developed within the course of 5 to 13 weeks in patients who had a history of sepsis and renal failure while undergoing hemodialysis are described. Baseline imaging from several weeks prior without myocardial calcification are shown for each of the three patients, demonstrating the rapid onset of these calcifications. The clinical significance of these findings is discussed. © RSNA, 2021.
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Affiliation(s)
- Joy Li
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Lydia Chelala
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Rydhwana Hossain
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Jean Jeudy
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Charles White
- Department of Radiology, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
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Washino M, Tanaka T, Nakase Y, Aoi T, Endo N, Ishikawa H, Morishita Y. A rare case of myocardial calcification secondary to acute myocarditis due to an Escherichia coli infection. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:775-781. [PMID: 33311807 PMCID: PMC7719460 DOI: 10.18999/nagjms.82.4.775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myocardial calcification secondary to acute myocarditis is a rare but possibly life-threatening complication. We report a 43-year-old woman with minimal change nephrotic syndrome who developed sepsis caused by Escherichia coli. We simultaneously detected the complication of acute myocarditis in the patient. Although echocardiography showed hypokinesis of the apical segment when acute myocarditis was diagnosed, no sign of myocardial calcification was observed. After two weeks, a CT showed myocardial calcification in the same area. Although myocardial calcification was still observed 12 months later, the patient’s cardiac function had improved.
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Affiliation(s)
- Masaya Washino
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Tomoki Tanaka
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yukiko Nakase
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Tomonori Aoi
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Nobuhide Endo
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Hideaki Ishikawa
- Department of Nephrology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
| | - Yoshihiro Morishita
- Department of Cardiology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
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A case of bi-ventricular extensive calcification caused by multiple factors. BMC Pediatr 2020; 20:85. [PMID: 32087707 PMCID: PMC7036240 DOI: 10.1186/s12887-020-1973-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/11/2020] [Indexed: 11/15/2022] Open
Abstract
Background Extensive myocardial calcification has a low incidence rate, but when the patients do have extensive myocardial cases, the prognosis is usually poor. Several sepsis-related extensive myocardial calcification cases have been reported, but there are cases of biventricular calcifications that are caused by multiple cases besides bacteremia and the treatment for it has a low percentage of success. Case presentation A 9 year old girl had an extensive biventricular calcification which is caused by multiple factors including multiple organ failure (heart, lung, liver, and kidney), aseptic cardiomyopathy, systemic inflammatory response syndrome, pulmonary hemorrhage, viral encephalitis. In this case study, the massive myocardial calcification present in the patient was classified as dystrophic. After the patient was transferred to the Intensive care unit, a series of rescue treatments such as anti-inflammatory factor storm were implemented to protect the organs. In the end, the patient was rescued from the rescue treatment procedure. After 18 months of follow-up, it was observed that the patient’s heart function returned to normal and it was observed that there was no change in myocardial calcification in the patient. Conclusion In this case study, it showcased a case of the diffused biventricular calcification that caused by multiple factors. Furthermore, the precise role of calcification on cardiac function was largely unknown and there has to be further follow-up observation on the patient.
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Cappelletti S, Piacentino D, Ciallella C. A systematic review of radiological and histological findings of septic myocardial calcifications. J Forensic Leg Med 2020; 74:102026. [PMID: 32755766 DOI: 10.1016/j.jflm.2020.102026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Myocardial calcification is a life-threatening condition that is a recognised complication of ischaemic heart disease, cardiac surgery, rheumatic fever, myocarditis and sepsis. Only sparse data, reporting the clinical symptoms, the anatomo-pathological findings, the imaging findings have been published and no exhaustive analysis of all these factors exists in literature. To date, there have been 26 published cases in the medical literature in which myocardial calcifications is the consequence of a septic status. In this review, we will describe the main imaging and histological findings, with particular attention to the known and hypothesized mechanisms of myocardial calcifications. The results of this study may help clinicians and forensic pathologists to identify possible unrecognized cases and inspire the development of an international registry by which to coordinate further research.
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Affiliation(s)
- Simone Cappelletti
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy; State Police Health Service Department, Ministry of Interior, Rome, Italy.
| | - Daria Piacentino
- Department of Psychiatry, Central Hospital, Sanitary Agency of South Tyrol, Bolzano-Bozen, Italy
| | - Costantino Ciallella
- Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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Hu JY, Fanaroff R, Jeudy J. Porcelain Heart: A Case of Diffuse Myocardial Calcification. Radiol Cardiothorac Imaging 2020; 2:e190204. [PMID: 33778584 DOI: 10.1148/ryct.2020190204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/30/2019] [Accepted: 01/27/2020] [Indexed: 11/11/2022]
Abstract
The pathophysiology of myocardial calcifications is variable and may have potentially fatal consequences if undiagnosed and untreated.
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Affiliation(s)
- Jiun-Yiing Hu
- Departments of Diagnostic Radiology & Nuclear Medicine (J.J.) and Pathology (R.F.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; and the University of Maryland School of Medicine (J.Y.H., J.J.).,J.Y.H. (e-mail: )
| | - Rachel Fanaroff
- Departments of Diagnostic Radiology & Nuclear Medicine (J.J.) and Pathology (R.F.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; and the University of Maryland School of Medicine (J.Y.H., J.J.).,J.Y.H. (e-mail: )
| | - Jean Jeudy
- Departments of Diagnostic Radiology & Nuclear Medicine (J.J.) and Pathology (R.F.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; and the University of Maryland School of Medicine (J.Y.H., J.J.).,J.Y.H. (e-mail: )
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Approach to Abnormal Chest Computed Tomography Contrast Enhancement in the Hospitalized Patient. Radiol Clin North Am 2020; 58:93-103. [DOI: 10.1016/j.rcl.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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