Mitral valve papillary muscle calcification

Case contributed by Suraindra Mark Rajadurai


Collapse with bradycardia and chest pain.

Patient Data

Age: 70 years old
Gender: Male

Non-con CT chest and CTA chest


No evidence of aortic dissection, hematoma or rupture. 

Focal linear calcification is present within the left ventricle which corresponds to the location of the mitral papillary muscles. Previous LAD stent with some irregular calcification proximal and distal to the stent.

Case Discussion

The initial CTA for this patient was ordered to rule out an aortic dissection, and due to the patient's acute presentation a full history had not been elicited at the time of scanning. 

In this case the LAD stent, LAD plaque and the presence of the papillary muscle calcification were quite suggestive of underlying coronary artery disease as a cause for the collapse, which was relayed to the treating ED physician. 

While the initial troponin was negative, a careful history yielded evidence of worsening angina on exertion, new ECG changes and the patient was admitted under cardiology with monitoring. The second troponin was elevated and the patient proceeded to coronary angiography for suspected in-stent stenosis/occlusion. 

Gated coronary CT studies are not usually performed in the acute ED setting. However, due to the increasing speed and definition on modern multi-detector CT, it is not-uncommon to see some relevant (though not necessarily diagnostic) cardiac findings on standard chest CT, which can be very helpful to the treating clinicians. 

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