Pericardial Calcification

Pathophysiology:  The commonest cause worldwide is infection, generally tuberculosis. In Western countries, trauma and surgery with resultant hemopericardium and dystrophic calcifications are the commonest causes of pericardial calcifications. 

Other causes include: post-infarction with pericarditis, post-viral pericarditis, uremic pericarditis, hypercalcemic states with metastatic calcifications, tumor with calcium matrix or following chemotherapy (eg. after pericardial lymphoma treatment).

CXR Findings:

1.      pericardial calcification may take two forms: (1) curvilinear and (2) “toothpaste-like”

2.      curvilinear pattern is commonest and is generally thicker than myocardial calcifications

3.      the calcification MUST be perimetric (ie. within the pericardium in at least one plane)

“Aunt Sophies”:  Must distinguish from myocardial calcification (perimetric and generally thicker than myocardial calcifications)