Massive Calcification in Infarcted Myocardium

Abstract

Calcification in myocardial infarcts is relatively uncommon, and only occasionally does the radiologist make the diagnosis during life. Although there are not more than twenty undoubted cases in the medical literature, the condition is not excessively rare. It occurs in a well defined group of patients with a characteristic clinical picture and is readily demonstrated by standard radiological technics. In a patient who has a calcified infarct, the diagnosis is clinically valuable in giving an unequivocal demonstration of the state of the myocardium, and in indicating the etiology of cardiac enlargement, which is usually present. The diagnosis is of some prognostic importance, since these patients, like others with coronary artery disease, are prone to sudden death. The diagnosis is of therapeutic significance in so far as the calcification may be mistaken for calcific pericarditis; calcified infarcts are not—at present—amenable to cardiac surgery. The more common cardiac calcifications—in valve rings, valve leaflets, coronary arteries, and pericardium—are now well known and readily recognized. Technics for their detection and identification have been established (19). The pathologic and clinical significance of each is well defined. It is the purpose of this paper to describe the pathologic background of calcified myocardial infarcts, their appearance, characteristic location, and contours, and to describe the patients in whom they occur. Material The study is based on 14 patients2 with calcified myocardial infarcts. Nine of the 14 infarcts have been confirmed by autopsy. Calcification was visible in films made during life in 8 patients: in 3 of the 9 autopsied cases, and in 5 others. Eight of the 9 postmortem examinations included special films of the heart. Seven of the hearts were examined by opaque injection and dissection of the coronary arteries. A series of 63 consecutive old myocardial infarcts without calcification, examined postmortem, was also studied for control purposes. Literature The first description of gross calcification in a myocardial infarct was published in 1908 by Simmonds (18), the lesion being unexpectedly discovered at autopsy. No additional proved case was reported until 1924, when Scholz (15) published a detailed account of a case demonstrated by x-ray films during the life of the patient, with autopsy verification and postmortem roentgen study. Subsequently, several additional reports have appeared (1–10, 12, 13). Parkinson's (11) study of cardiac aneurysms includes a proved case with massive calcification in the aneurysmal wall, and a second case, unproved but convincing. Schwedel and Gross's (17) study of cardiac aneurysms mentions a proved case, as does the chapter on cardiac aneurysms in Schwedel's book (16). Several of the calcified infarcts have been demonstrated during life (2, 3, 5, 7, 9-12, 15), and a number of postmortem films have been published (1, 2, 5, 8, 11, 15, 16).