Severely Calcified Pericardium: The Crown of Thorns Jose Rubio-Alvarez, MD, PhD, Anxo Martinez de Alegria, MD, PhD, Juan Sierra-Quiroga, MD, PhD, and Jose Manuel Martinez-Comendador, MD, PhD Departments of Cardiac Surgery, and Radiology, University Hospital Santiago de Compostela, La Coruña, Spain FEATURE ARTICLES Fig 1. Fig 2. A 40-year-old woman was admitted for heart failure. Echocardiography revealed a thickened and calcified pericardium. A chest radiograph showed pericardial calcification (Fig 1A). She did not report any epidemiology or contact with tuberculosis. The patient underwent surgery through a median sternotomy. At surgery, a large quantity of calcium was observed in the pericardium, mostly in the diaphragmatic surface, atrioventricular grooves, and great arteries, but only Address correspondence to Dr Rubio-Alvarez, University Hospital Santiago de Compostela, Framan-Bugallido 15866, La Coruña, Spain; e-mail: [email protected]. © 2012 by The Society of Thoracic Surgeons Published by Elsevier Inc partial pericardiectomy was performed. No specific cause was found after histopathologic examinations. Postoperative multidetector computed cardiac tomography was performed, showing dense pericardial calcification with infiltration into the anterior, diaphragmatic, and posterior wall of the heart (Fig 1B). A three-dimensional reconstruction of the myocardial calcification is shown in Figure 1C. A volume rendering of the heart showed dense pericardial calcification over the atrioventricular groove, diaphragmatic wall, and great arteries (Fig 2). Multidetector computed cardiac tomography should be a complementary technique in patients with pericarditis and extensive calcification, because it offers valuable information for preoperative planning. Ann Thorac Surg 2012;93:325 • 0003-4975/$36.00 doi:10.1016/j.athoracsur.2011.06.013
