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Coronary Artery Calcification Seen Through Chest Radiography.

Neves PD, Bridi RA, Elias RM, Moyses RM - J Clin Med Res (2015)

Bottom Line: Aortic arch calcification has been associated with CV mortality in the general population.Such images are not usually seen, although the risk of vascular calcification is high in this population, and is closely related to CV risk.Such a finding is intriguing and should alert nephrologists and cardiologists for the high risk of CV death in these patients.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Division, University of Sao Paulo, Sao Paulo, SP, Brazil.

ABSTRACT
Patients with end-stage renal disease (ESRD) on dialysis have poor overall survival, and cardiovascular (CV) is the main cause of mortality among these patients. Coronary calcification is an independent predictor of mortality and CV events in dialysis patients and can be accessed by using a computerized tomography scanning. The high cost of this procedure, however, precludes routine implementation of this method for the purposes of risk stratification. Aortic arch calcification has been associated with CV mortality in the general population. Also, vascular calcification beyond the thoracic aorta has been shown to be associated with mortality in ESRD patients. We presented here a case of a young patient with ESRD in which the coronary calcification could be cleared seen through simple chest radiography. This is a 35-year-old man with a history of ESRD secondary to pyelonephritis, who was receiving conventional hemodialysis thrice a week for the last 5 years. He was submitted to chest radiography as part of routine annual cardiac screening. His blood pressure was within the target limits, although much higher in lower limbs, generating a high ankle brachial index of 1.3. He also had secondary hyperparathyroidism. His physical examination was unremarkable, except for the presence of non-functioning arteriovenous fistulas in both arms and a central venous catheter. The last routine blood test showed calcium 9.0 mg/dL, phosphate 5.7 mg/dL, potassium 4.7 mEq/L, creatinine 7.4 mg/dL, alkaline phosphatase 175 U/L, and parathyroid hormone 1,745 pg/mL. Surprisingly, the chest radiography revealed a calcified aortic valve and a calcified coronary artery. This patient had sudden cardiac death few months after this radiography had been taken. We present here a case of coronary calcification that can be seen through simple chest radiography. Such images are not usually seen, although the risk of vascular calcification is high in this population, and is closely related to CV risk. Chest radiographs, nearly universally available provide a method for assessing coronary artery calcification. Such a finding is intriguing and should alert nephrologists and cardiologists for the high risk of CV death in these patients.

No MeSH data available.


Related in: MedlinePlus

Chest radiography showing calcified right coronary and aortic valve.
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Figure 1: Chest radiography showing calcified right coronary and aortic valve.

Mentions: This is a 35-year-old man with a history of ESRD who was receiving conventional hemodialysis for the last 5 years. He was submitted to chest radiography as part of routine annual cardiac screening. As associated comorbidity he had hypertension which has been treated with atenolol, atensin and amlodipine. His blood pressure was within the target limits, although much higher in lower limbs, generating a high ankle brachial index (ABI) of 1.3. He also had secondary hyperparathyroidism. The last routine blood test showed calcium 9.0 mg/dL, phosphate 5.7 mg/dL, potassium 4.7 mEq/L, creatinine 7.4 mg/dL, alkaline phosphatase 175 U/L, and parathyroid hormone 1,745 pg/mL. The chest radiography revealed a tunneled venous catheter, and incidentally found demarcated images on cardiac area (Fig. 1). The necklace shape extends from the cardiac apex to the base. A small circular shape is also displayed, superimposed on the first one. The lesions seen in this image correspond to a calcified right coronary and aortic valve. Parathyroidectomy (PTX) was indicated, but unfortunately, this patient had sudden cardiac death few months after this radiography had been taken. FGF-23, accessed afterward, was 1,327 pg/mL.


Coronary Artery Calcification Seen Through Chest Radiography.

Neves PD, Bridi RA, Elias RM, Moyses RM - J Clin Med Res (2015)

Chest radiography showing calcified right coronary and aortic valve.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522993&req=5

Figure 1: Chest radiography showing calcified right coronary and aortic valve.
Mentions: This is a 35-year-old man with a history of ESRD who was receiving conventional hemodialysis for the last 5 years. He was submitted to chest radiography as part of routine annual cardiac screening. As associated comorbidity he had hypertension which has been treated with atenolol, atensin and amlodipine. His blood pressure was within the target limits, although much higher in lower limbs, generating a high ankle brachial index (ABI) of 1.3. He also had secondary hyperparathyroidism. The last routine blood test showed calcium 9.0 mg/dL, phosphate 5.7 mg/dL, potassium 4.7 mEq/L, creatinine 7.4 mg/dL, alkaline phosphatase 175 U/L, and parathyroid hormone 1,745 pg/mL. The chest radiography revealed a tunneled venous catheter, and incidentally found demarcated images on cardiac area (Fig. 1). The necklace shape extends from the cardiac apex to the base. A small circular shape is also displayed, superimposed on the first one. The lesions seen in this image correspond to a calcified right coronary and aortic valve. Parathyroidectomy (PTX) was indicated, but unfortunately, this patient had sudden cardiac death few months after this radiography had been taken. FGF-23, accessed afterward, was 1,327 pg/mL.

Bottom Line: Aortic arch calcification has been associated with CV mortality in the general population.Such images are not usually seen, although the risk of vascular calcification is high in this population, and is closely related to CV risk.Such a finding is intriguing and should alert nephrologists and cardiologists for the high risk of CV death in these patients.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Division, University of Sao Paulo, Sao Paulo, SP, Brazil.

ABSTRACT
Patients with end-stage renal disease (ESRD) on dialysis have poor overall survival, and cardiovascular (CV) is the main cause of mortality among these patients. Coronary calcification is an independent predictor of mortality and CV events in dialysis patients and can be accessed by using a computerized tomography scanning. The high cost of this procedure, however, precludes routine implementation of this method for the purposes of risk stratification. Aortic arch calcification has been associated with CV mortality in the general population. Also, vascular calcification beyond the thoracic aorta has been shown to be associated with mortality in ESRD patients. We presented here a case of a young patient with ESRD in which the coronary calcification could be cleared seen through simple chest radiography. This is a 35-year-old man with a history of ESRD secondary to pyelonephritis, who was receiving conventional hemodialysis thrice a week for the last 5 years. He was submitted to chest radiography as part of routine annual cardiac screening. His blood pressure was within the target limits, although much higher in lower limbs, generating a high ankle brachial index of 1.3. He also had secondary hyperparathyroidism. His physical examination was unremarkable, except for the presence of non-functioning arteriovenous fistulas in both arms and a central venous catheter. The last routine blood test showed calcium 9.0 mg/dL, phosphate 5.7 mg/dL, potassium 4.7 mEq/L, creatinine 7.4 mg/dL, alkaline phosphatase 175 U/L, and parathyroid hormone 1,745 pg/mL. Surprisingly, the chest radiography revealed a calcified aortic valve and a calcified coronary artery. This patient had sudden cardiac death few months after this radiography had been taken. We present here a case of coronary calcification that can be seen through simple chest radiography. Such images are not usually seen, although the risk of vascular calcification is high in this population, and is closely related to CV risk. Chest radiographs, nearly universally available provide a method for assessing coronary artery calcification. Such a finding is intriguing and should alert nephrologists and cardiologists for the high risk of CV death in these patients.

No MeSH data available.


Related in: MedlinePlus