A systematic review of radiological and histological findings of septic myocardial calcifications

Cappelletti, Simone; Piacentino, Daria; Ciallella, Costantino

doi:10.1016/j.jflm.2020.102026

Cited by 6 publications

(5 citation statements)

References 41 publications

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“…The best evaluation quality and precision can be reached without EMB, by chest CT, which might be indicated by clinical symptoms, a chest X-ray showing an increased density of the heart outline and/or large deposits or an EchoCG detecting increased echo-density and acoustic shadowing of the myocardium, along with hypokinesia. If CT is contraindicated, CMR can reveal extensive LGE and pericardial effusion [ 159 ].…”

Section: Resultsmentioning

confidence: 99%

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

et al. 2022

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Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.

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Section: Resultsmentioning

confidence: 99%

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

et al. 2022

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“…Forensic pathologists commonly identify calcifications in the heart, typically affecting the coronary arteries, valve leaflets, and mitral valve annulus. However, calcium deposition in the myocardium itself is much less common (1 -3). While calcium deposition can reportedly occur idiopathically in the myocardium, it is usually attributable to either metastatic or dystrophic calcification (1, 3, 4).…”

Section: Discussionmentioning

confidence: 99%

“…While calcium deposition can reportedly occur idiopathically in the myocardium, it is usually attributable to either metastatic or dystrophic calcification (1, 3, 4). Metastatic calcification is secondary to impairment of calcium and phosphorus metabolism, which is most frequently seen in patients with chronic renal failure or hyperparathyroidism (1 -3). Dystrophic calcification, on the other hand, refers to the deposition of calcium salts in damaged or necrotic tissues in the absence of deranged calcium metabolism (1 -5).…”

Section: Discussionmentioning

confidence: 99%

“…Metastatic calcification is secondary to impairment of calcium and phosphorus metabolism, which is most frequently seen in patients with chronic renal failure or hyperparathyroidism (1 -3). Dystrophic calcification, on the other hand, refers to the deposition of calcium salts in damaged or necrotic tissues in the absence of deranged calcium metabolism (1 -5). In the context of dystrophic calcification, the precipitating tissue damage can occur secondary to various clinical conditions including sepsis, myocardial infarction, radiation therapy, anatomic cardiac abnormalities, especially anomalies of the coronary arteries, and other factors leading to myocardial ischemia (1 -10).…”

Section: Discussionmentioning

confidence: 99%

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Myocardial Calcification: An Unusual Complication of Remote Trauma With Coidentified Amyloidosis

Wilkinson,

Krywanczyk

2023

Academic Forensic Pathology

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We present the heart of a 38-year-old man with paraplegia due to a remote traumatic spinal cord injury. In the 20 years following his injury, he experienced chronic decubitus ulcers, osteomyelitis, neurogenic bladder, malnutrition, and urinary tract infections. He was admitted to the hospital with septic shock secondary to multiple decubitus ulcers and osteomyelitis and expired after a two-month hospitalization. At autopsy, there was marked replacement of left ventricle and interventricular septal myocardium by gritty, firm, yellow-white tissue. Microscopic examination demonstrated a remote infarct with marked dystrophic calcification and unexpected amyloid deposition. This example demonstrates the extraordinary extent to which dystrophic calcifications can replace myocardium and highlights multiple potential etiologies of myocardial calcifications. Of note, this is the first report documenting myocardial calcification as a complication of remote, non-iatrogenic trauma. The role of the amyloidosis in the development of calcification is unclear, but a contributory effect cannot be excluded.

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“…Histopathological changes in the myocardium have been shown in autopsy studies, with myocardial inflammation and vasculitis, but the pathophysiology of cardiac involvement in leptospirosis is inadequately understood [ 1 ]. Cardiac involvement, demonstrated clinically or electrocardiographically, predicts poor outcome [ 1 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Diffuse Myocardial Calcifications Caused by Leptospirosis

Lesjak,

Pirnat

2023

Cureus

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Severe leptospirosis is defined by multiple organ failure. Cardiac involvement is an uncommon complication in patients with leptospirosis, and the pathophysiology of it is not well understood. Diffuse myocardial calcifications connected with sepsis are infrequent, and their effect on heart function is hard to predict. They can lead to conduction disorders and arrhythmias, thereby causing sudden death. Myocardial calcifications are usually revealed incidentally by radiological investigations such as computed tomography (CT) scan in patients with or after sepsis and are commonly unidentified in practice because most cases progress gradually. This case report involves a 51-year-old male who presented to the emergency department with sepsis. The patient was diagnosed with leptospirosis, causing septic cardiomyopathy and diffuse calcifications of the myocardium of the left ventricle. This case highlights the importance of multimodality imaging and a multidisciplinary approach to diagnoses since early recognition and treatment are essential. Follow-up of such patients is necessary to monitor the systolic function of the left ventricle and cardiac arrhythmia.

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A systematic review of radiological and histological findings of septic myocardial calcifications

Cited by 6 publications

References 41 publications

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

Myocardial Calcification: An Unusual Complication of Remote Trauma With Coidentified Amyloidosis

Diffuse Myocardial Calcifications Caused by Leptospirosis

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