‘Heart of stone’: an unusual post-actinic sequela

A 60-year-old man with a history of Hodgkin's lymphoma was admitted to our institution for congestive heart failure. Twenty years earlier, he had received chemotherapy and radiotherapy and had developed late post-actinic sequela involving the lungs and heart. Chest X-ray and echocardiographic examination showed pulmonary congestion and fibrosis, pleural, and pericardial effusion along with reduced left ventricular ejection fraction (Panel A). However, the clinical picture was predominantly characterized by evidence of severe left ventricular calcifications extending inward from the epicardium and involving the interventricular septum and mitral apparatus, as documented on computed tomography chest scan (Panels B andC; Supplementary material online, Video S1Supplementary material online,Video S1). These impressive calcifications were also the prevailing features on coronary angiography which revealed the absence of significant coronary stenoses (Panel D; Supplementary material online, Video S2Supplementary material online,Video S2). Chest radiation exposure is associated with a substantial risk for the subsequent development of pulmonary and cardiovascular disease; however, massive calcifications that penetrate deep into the myocardial layers of the left ventricle have rarely been reported.
Source: European Heart Journal - Category: Cardiology Source Type: research