Pericardial calcification: an uncommon presentation of rheumatic heart disease

Description 

A 42-year-old man presented to cardiology outpatient department with complaints of gradually progressive dyspnoea on exertion, easy fatigability and mild intermittent atypical chest pain for the past 9 months. Chest radiograph revealed mild cardiomegaly, enlarged left atrium and presence of multiple focal calcific specks along right inferior and upper left cardiac border (figure 1A). Transthoracic echocardiography showed thickened mitral valve leaflets with restricted mobility of posterior leaflet and mitral stenosis with mitral regurgitation.

Figure 1

Frontal chest radiograph (A) shows cardiomegaly with enlarged left atrium along with linear calcific foci (black arrows) along cardiac borders, which were confirmed to be involving the pericardium (white arrows) on coronal reconstructed maximum intensity projection images of CT angiography (B, C). Short-axis (D) and long-axis (E) reconstructions reveal thickening of mitral valve (MV) leaflets along with speck of calcification involving the anterior MV leaflet (dotted black arrow) along with...

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