Case Report Idiopathic massive myocardial calcification: a case report and review of the literature Brit S. Shackley a, ⁎ , Thao P. Nguyen b , Kalyanam Shivkumar c , Paul J. Finn c , Michael C. Fishbein a a Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA 90095-1732, USA b Division of Cardiology, UCLA David Geffen School of Medicine, Los Angeles, CA 90095-1732, USA c Department of Radiology, UCLA David Geffen School of Medicine, Los Angeles, CA 90095-1732, USA Received 30 December 2009; received in revised form 6 March 2010; accepted 20 April 2010 Abstract We report a rare case of massive myocardial calcification in a 42-year-old male who presented with symptoms of congestive heart failure and arrhythmia. Myocardial calcification is most commonly associated with myocardial infarction or, less commonly, hypercalcemia. This case is particularly unusual due to the lack of any known predisposing risk factors, including normal coronary arteries, normal renal function, and normal serum calcium levels. Alternative etiologies are discussed accompanied by a review of the literature. © 2011 Elsevier Inc. All rights reserved. Keywords: Myocardial calcification; Restrictive cardiomyopathy; Idiopathic congestive heart failure 1. Introduction Massive myocardial calcification is a very rare finding and is most commonly seen in the setting of a prior myocardial infarction [1,2]. Calcification can occur by either dystrophic or metastatic pathways. Dystrophic calcification occurs due to calcium deposition in tissue that is necrotic from any cause. Therefore, it may also be seen in various other forms of myocardial insult such as myocarditis, ventricular aneurysms, myocardial fibrosis, tuberculosis, sarcoidosis, and hemorrhage [3–7]. Rarely, idiopathic mitral annular calcification (MAC) can also extend into the adjacent myocardium [2]. Metastatic calcification occurs in normal tissue due to elevated serum calcium levels and is frequently associated with chronic renal failure [7–9]. We present an unusual case of massive myocardial calcification in which there are no apparent predisposing factors. 2. Case report A 42-year-old male was transferred from an outside hospital with a diagnosis of idiopathic restrictive cardiomy- opathy. He had a past medical history of coarctation of the aorta, status post repair at age 5, and more recently, recurrent pericardial effusion which was treated with a pericardial window 5 years prior to this admission. At that time, the patient also developed ventricular tachycardia, necessitating placement of an automatic implantable cardioverter defibril- lator (AICD). The patient was hospitalized on multiple occasions over the ensuing 5 years for symptoms related to congestive heart failure. During this time, he underwent endomyocardial biopsy, which was unrevealing. Radio- frequency ablation was also attempted without improvement. One year prior to the present admission, he began experiencing multiple AICD shocks and recurrent ventric- ular tachycardia. Upon presentation to UCLA Medical Cardiovascular Pathology 20 (2011) e79 – e83 No funding was provided for the manuscript or for any of its authors. The authors declare no competing financial interests. ⁎ Corresponding author. Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Box 951732, Los Angeles, CA 90095-1732, USA. Tel.: +1 825 5719; fax: +1 310 267 2058. E-mail address: bshackley@mednet.ucla.edu (B.S. Shackley). 1054-8807/10/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.carpath.2010.04.004