two patients with chest pain and same diagnosis

 

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Doctor's Information

Name : Morteza
Family :Sanei Taheri
Affiliation : Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree: Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Maryam Shabani

 

Case Section

Cardiovascular

 

Patient's Information

Gender : Female
Age : 50

 

Clinical Summary

Case 1: 52 year old woman Case 2: 60 year old woman . The second patient referred to the emergency with abdominal pain.

 

 

Imaging Findings

FIGURE1-3 show mitral valve calcification &left atrial enlargment. In the second case (figure 4-6); demonstrate marked left atrium enlargement (15 cm axial diameter).There is ill-defined linear hypodenceties in the spleen extended to the cortex without enhancement, indicative of splenic infarct. Both patients had known history of mitral stenosis. The first one had previous history of rheumatoid heart disease and echocardiography showed mitral stenosis.

 

Differential Diagnosis

In the first patient: 1.coronary artery calcification

 

Final Diagnosis

Mitral stenosis (with splenic infarct in the second patient)

 

Discussion (Related Text)

Mitral valve calcification is highly suggestive of rheumatic valvular disease and is seen on the chest radiographs of approximately 40% of patients with mitral stenosis. It is even more common in patients with stenosis and regurgitation. Atherosclerotic calcification of the mitral annulus occurs in approximately 10% of the elderly population .It appears as circular, ovoid, C-shaped, or J-shaped calcification in the mitral annulus and can lead to mitral valve incompetence.(1) Rheumatic heart disease, which causes the mitral valve leaflets to become thickened and calcified, is the most common cause of mitral stenosis. Because involvement of the chordae tendineae causes tethering, the mitral valve is often regurgitant as well as stenotic . Pure mitral stenosis results in mild left atrial enlargement. The left ventricle is not enlarged unless there is also mitral regurgitation. Calcification of the mitral valve can be seen in patients with rheumatic mitral valve disease (the first patient); however, it may also be seen in older patients with sclerosis of the valve. The left atrial wall may also calcify as a result of rheumatic endocarditis. (2)

 

References

1. brant, Fundamentals of Diagnostic Radiology 2. haaga , CT and MRI of the Whole Body,1142-1143

 

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