Skip to main content
2025 SCMR Conference Main banner
Final Program


Schedule at a Glance
Back

Quick Fire Cases

Quick Fire 2- Miscellaneous II

Walking on Eggshells: A Case of Myocardial Calcification (QF_TH_049)

Thursday, January 30, 2025
4:20 PM – 4:30 PM East Coast USA Time
Location: Blue Room PreFunction
Description of Clinical Presentation: 34-year-old male without significant past medical history presented to the emergency department with several hours of abdominal pain, vomiting, diarrhea and fever. Vitals were remarkable for blood pressure of 86/53 mmHg and heart rate 123 beats per minute. Physical examination was notable for regular rhythm with tachycardia and abdominal distension with diffuse tenderness. Labs were significant for white blood cell count 3100 /µL (normal 3500-10500 /µL), creatinine 1.54 mg/dL (normal 0.6-1.3 mg/dL), high sensitivity troponin 144 pg/mL (normal 0-20 pg/mL), C-reactive protein 48.1 mg/L (normal 0-10 mg/L), lactic acid 6.2 mMol/L (normal 0.5-2.0 mMol/L), and blood cultures positive for Streptococcus pyogenes. The patient was admitted for 3 weeks with toxic shock syndrome. He developed multiple system organ failure requiring continuous renal replacement therapy, intubation with sedation, and vasopressor support. He was treated with intravenous immunoglobulin therapy and antibiotics and eventually was discharged with full recovery.  

Diagnostic Techniques and Their Most Important Findings: During the hospitalization, an echocardiogram showed a mildly reduced left ventricular ejection fraction (LVEF) of 44% with apical akinesis suggestive of stress cardiomyopathy. A computed tomography (CT) performed towards the end of the hospitalization showed extensive calcification of the left ventricle (LV) not previously present on CT 3 weeks earlier. Six weeks following his hospitalization, further imaging was completed. A cardiac CT again showed extensive, circumferential calcification of the subepicardial and mid-myocardial LV, the interventricular septum, and the right ventricle (Figure 1). Cardiac magnetic resonance imaging (MRI) showed subepicardial and mid-myocardial delayed gadolinium enhancement of the basal to apical anterolateral and inferolateral segments as well as the mid to apical, inferior, inferoseptal, anteroseptal, and anterior LV segments. There was associated elevated global T1 (1175 msec) and T2 (55 msec) signals and extracellular volume (31%) suggesting possible myocarditis (Figure 3). There was no thickening or enhancement of the pericardium to suggest pericardial involvement. Repeat echo showed a normal LVEF of 60% without evidence of restriction.  

Learning Points from this Case: Myocardial calcification is a rare complication of severe septic shock thought to be due to myocardial calcium dysregulation leading to deposition of calcium in areas of necrosis. This case demonstrates rapid extensive deposition of calcium within the myocardium over a few short weeks due to toxic shock syndrome. The cardiac MRI 6 weeks after recovery showed edema and increased extracellular volume in the areas of calcified myocardium suggesting the underlying inflammation may be a driving factor for rapid calcium deposition. The pericardium was not involved in the pathology; therefore, constrictive pericardial disease is less likely to develop in the future than restrictive cardiomyopathy. However, the long-term prognosis of myocardial calcification is still poorly understood.