Porcelain left atrium, also known as coconut left atrium, is a term used when a large part of or the entire left atrial wall becomes calcified.

Terminology

Some publications use the terms "porcelain left atrium" and "coconut left atrium" as synonymous while others use the term "coconut left atrium" when it involves the interatrial septum ^12,14.

Epidemiology

There is a slight female predilection ¹².

Clinical presentation

Some patients may present with longstanding symptoms although others may be asymptomatic. A concurrent presence of atrial fibrillation and a past history of mitral valve surgery is common.

Pathology

Porcelain left atrium is most commonly a rare complication of rheumatic heart disease ¹². It has also been described in the setting of end-stage renal disease ⁵.

Radiographic features

Plain radiograph and CT

Calcification of large parts of the left atrial pericardium may suggest the diagnosis.

Treatment and prognosis

It may require an endoatriectomy at the time of mitral valve replacement ².

History and etymology

It was initially described by H Claude and P Levaditi in 1898 ⁸. 

Differential diagnosis

If it involves only the posterior free wall consider:

• pericardial calcification affecting that portion: there may be pericardial calcification affecting other segments

See also

• MacCallum patch: calcification confined to posterior wall, thought to be due to a regurgitant jet

• Panzerherz (porcelain heart): entire calcification of the pericardium

• pericardial calcification

• atrial calcificiation

  • left atrial calcification

    • porcelain left atrium

  • right atrial calcification