CALCIFICATION OF THE VENTRICULAR SEPTUM

 

Dystrophic calcification of the myocardium is a nonspecific manifestation of sever previous myocardial injury. It occurs in areas of sever necrosis, fibrosis or hemorrhage (1).

 

 

 

 

ETIOLOGY

 

There are many causes of dystrophic calcified myocarditis:

  1. Infectious etiologies include Coxsackie B1, 2, 3, 4; Coxsackie A3 (2-4); enterovirus (6); echovirus II (5); Toxoplasma infection (7): Herpes simplex type II (1).
  2. Maternal cocaine abuse has been implicated as a possible cause of fetal myocardial damage with subsequent calcification.

 

 

 

ULTRASOUND

 

  1. Calcification in the interventricular wall (linear echogenic areas that may not demonstrate shadowing)
  2. There may be calcification or thickening of the free walls of the ventricles.
  3. +/- pericardial effusion.
  4. Ventriculomegaly.
  5. Cardiac dysfunction and failure.
  6. Hydrops in cases of severe cardiac dysfunction.

 

 

 

 

DIFFERENTIAL DIAGNOSIS

 

  1. Cardiac tumors that may have an echogenic appearance or calcification include:
  2. Idiopathic infantile arterial calcification occurs in the vessels (coronary artery, aorta and pulmonary artery), and not primarily in the myocardium.
  3. Calcification of the infindibulum and pulmonary artery in twin-twin transfusion syndrome.
  4. Not all calcified areas in the heart are myocardium. The calcification must therefore be accurately be classified as myocardial, epi- or pericardial.

 

 

 

 

 

REFERENCES

 

 

  1. Mitra AG, O’Malley D, Banks PM, Kelly M. Myocardial calcification in a fetus. J Ultrasound Med 2004;23:1385-1390.
  2. Goren A, Kaplan M, Glaser J. et.al. Chronic neonatal coxsackie myocarditis. Arch Dis Child 1989;4:404-406.
  3. Baker DA, Phillips CA. Maternal and neonatal infection with coxsackie virus. Obstet Gynecol 1980;55(suppl):125-155.
  4. Bates HR Jr. Coxsackie virus B13 calcific pancarditis and hydrops fetalis. Am J Obstet Gynecol 1970;106:629-630.
  5. Bose CL, Gooch WM III, Sanders GO et.al. Dissimilar manifestations of intrauterine infection with echovirus 11 in premature twins. Arch Pathol Lab Med 1983;107:361-363.
  6. Stallion A, Rafferty JF, Wagner BW et.al. Myocardial calcification: a predictor of poor outcome for myocarditis treated with extracorporeal life support. J Pediatr Surg 1994;29:492-494.
  7. Garcia AGP, Torres AC, Pegado CS. Congenital toxoplasmic myocarditis: case report of unusual presentation. Ann Trop Paediatr 1985;5:277-280.