Pericardial calcification usually occurs in patients with a history of pericarditis.
- previous trauma or prior pericarditis
- later sequelae of rheumatic heart disease
- malignant pericardial involvement (e.g. mediastinal teratoma)
- post-radiotherapy 5
On chest radiography, the location of the calcifications can help differentiate pericardial calcifications from myocardial calcifications caused by ventricular aneurysms. While pericardial calcification is seen more commonly over the right ventricle, myocardial calcifications are seen more commonly over the left ventricle 3.
The differential diagnosis for pericardial calcifications include:
- constrictive pericarditis: in the setting of heart failure with concern for constrictive pericarditis or restrictive cardiomyopathy, calcifications are highly suggestive of the former
- chronic adhesive pericarditis in the absence of constriction: less dense with a more patchy distribution 1
- rheumatic pericarditis 2
- myocardial calcification (e.g. from left ventricular aneurysm)
- 1. Fuster V. Hurst's the Heart. McGraw-Hill Professional Pub. (2010) ISBN:0071636463. Read it at Google Books - Find it at Amazon
- 2. Dan Longo, Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. Harrison’s Principles of Internal Medicine, 18E. McGraw-Hill Prof Med/Tech. (2012) ISBN:007174889X. Read it at Google Books - Find it at Amazon
- 3. Macgregor JH, Chen JT, Chiles C et-al. The radiographic distinction between pericardial and myocardial calcifications. AJR Am J Roentgenol. 1987;148 (4): 675-7. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Wang ZJ, Reddy GP, Gotway MB et-al. CT and MR imaging of pericardial disease. Radiographics. 2003;23 Spec No : S167-80. doi:10.1148/rg.23si035504 - Pubmed citation
- 5. Paniagua González Miguel, Sánchez Alegre María Luisa. Extensive pericardial calcification secondary to radiotherapy, causing mixed constrictive-restrictive pathology. (2017) BJR|case reports. 3 (4): 20170036. doi:10.1259/bjrcr.20170036 - Pubmed