A 69-year-old man, with a history of hypertension, dyslipidemia, stroke in 1995 and left thoracic-abdominal trauma in 1999 resulting in hemopneumothorax after being hit by an ox, was referred for cardiology consultation following the incidental finding on thoracic-abdominal computed tomography (CT) of an extensive area (54 mm×36 mm×20 mm) of irregular, linear calcifications located posteriorly high in the pericardial sac (Figure 1). Transthoracic and transesophageal echocardiography and thoracic CT angiography were performed to clarify whether the calcification was intravascular or extravascular and to exclude a tumor.

Figure 1.

Thoracic computed tomogram showing a large lesion with irregular calcifications.

(0.11MB).

The echocardiogram showed a rounded mass with calcified walls attached to and slightly compressing the left atrium and the coronary sulcus of the lateral and anterior walls, with apparent fibrocalcification of the myocardium of the basal segment of the lateral wall, which was thinner, hyperechogenic and akinetic (Figure 2). CT angiography showed the lesion high in the pericardial sac in extensive contact with the pericardium, suggesting that its epicenter was within this structure. The lesion appeared to be of extravascular origin, possibly a consequence of the previous trauma (Figure 3).

Figure 2.

Echocardiogram showing the lesion. AE: left atrium; VE: left ventricle.

(0.28MB).

Figure 3.

Thoracic computed tomography angiogram showing lesion after contrast injection.

(0.14MB).

The initial investigation focused on assessing the lesion, the other cardiac chambers, particularly the left atrial appendage, and the patient's hemodynamic status.

A brief review of the literature revealed descriptions of pericardial masses, cysts and calcifications (some due to trauma), but no case with similar characteristics to the one described above.