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Porcelain heart

Gianluca Rigatelli, Paolo Cardaioli, Massimo Giordan, Loris Roncon
DOI: http://dx.doi.org/10.1093/eurheartj/ehl139 51 First published online: 3 July 2006

A 65-year-old hypertensive man with shortness of breath and atypical thoracic pain underwent coronary angiography for suspected coronary artery disease. At the admission, the cardiac examination did not reveal murmurs, Kussmaul's sign, pericardial frictional rub, or pericardial knock. No abnormalities of inflammatory markers or renal function was observed. Previous chest X-ray demonstrated a normal cardiothoracic ratio with mild apical calcification of the pericardium. EKG was noted as normal. A transthoracic echocardiography was conducted with very poor acoustic window and was positive only for moderate diastolic dysfunction. An ergometric test was aborted for early dyspnoea. On direct fluoroscopy during coronary diagnostic catheter advancement, massive calcifications on the entire pericardium were observed in both right anterior oblique (Panel A) and lateral (Panel B) views (coronary diagnostic catheter is engaging the left coronary ostium). No coronary disease or left ventricle dysfunction was detected during cardiac catheterization. It has been postulated that the poor acoustic window was caused by the severe calcifications, probably due to a misdiagnosed chronic pericarditis.

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