Journal of the American College of Cardiology Ó 2014 by the American College of Cardiology Foundation Published by Elsevier Inc.
Vol. 63, No. 8, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.10.076
IMAGES IN CARDIOLOGY
The Man With a Heart of Stone Julie Lorraine Rosenthal, MD, Deborah H. Kwon, MD, Edward G. Soltesz, MD, MPH, Paul Schoenhagen, MD, Carmela Tan, MD, James D. Thomas, MD Cleveland, Ohio
From the Cleveland Clinic, Cleveland, Ohio. Manuscript received September 27, 2013; accepted October 3, 2013.
64-year-old man who underwent remote coronary artery bypass surgery presented with acute vision loss. Findings on physical examination and vital signs were unremarkable except for blindness in the left eye. Laboratory values were significant for elevated troponin T and normal calcium, parathyroid hormone, and vitamin D levels. Electrocardiography showed left ventricular hypertrophy with strain. Chest x-ray (A) revealed organized hyperdense, linear material throughout the heart (arrow). Echocardiography (B and C, Online Video 1) showed a mobile echodensity on the posterior papillary muscle and echogenic myocardium. Computed tomography and cardiac magnetic resonance imaging (D and E, Online Video 2) showed that the hyperdense material was calcium and did not compromise ventricular function. Panel F and Online Video 3 show a 3-dimensional computed tomography reconstruction of the calcified myocardium, which was also demonstrated on angiography (Online Video 4). The patient underwent an uncomplicated excision of the mobile mass with redo coronary artery bypass grafting. Pathological analysis (G and H) showed fibrinous material with calcium consistent with a calcified amorphous tumor (1). The etiology of the myocardial calcification remains unclear.
A
REFERENCE
1. Reynolds C, Tazelaar HD, Edwards WD. Calcified amorphous tumor of the heart (cardiac CAT). Hum Pathol 1997;28:601–6.
Vol. 63, No. 8, 2014 ISSN 0735-1097/$36.00 http://dx.doi.org/10.1016/j.jacc.2013.10.076
IMAGES IN CARDIOLOGY
The Man With a Heart of Stone Julie Lorraine Rosenthal, MD, Deborah H. Kwon, MD, Edward G. Soltesz, MD, MPH, Paul Schoenhagen, MD, Carmela Tan, MD, James D. Thomas, MD Cleveland, Ohio
From the Cleveland Clinic, Cleveland, Ohio. Manuscript received September 27, 2013; accepted October 3, 2013.
64-year-old man who underwent remote coronary artery bypass surgery presented with acute vision loss. Findings on physical examination and vital signs were unremarkable except for blindness in the left eye. Laboratory values were significant for elevated troponin T and normal calcium, parathyroid hormone, and vitamin D levels. Electrocardiography showed left ventricular hypertrophy with strain. Chest x-ray (A) revealed organized hyperdense, linear material throughout the heart (arrow). Echocardiography (B and C, Online Video 1) showed a mobile echodensity on the posterior papillary muscle and echogenic myocardium. Computed tomography and cardiac magnetic resonance imaging (D and E, Online Video 2) showed that the hyperdense material was calcium and did not compromise ventricular function. Panel F and Online Video 3 show a 3-dimensional computed tomography reconstruction of the calcified myocardium, which was also demonstrated on angiography (Online Video 4). The patient underwent an uncomplicated excision of the mobile mass with redo coronary artery bypass grafting. Pathological analysis (G and H) showed fibrinous material with calcium consistent with a calcified amorphous tumor (1). The etiology of the myocardial calcification remains unclear.
A
REFERENCE
1. Reynolds C, Tazelaar HD, Edwards WD. Calcified amorphous tumor of the heart (cardiac CAT). Hum Pathol 1997;28:601–6.
