Calcification of the Left Auricle

During the past three years, considerable interest has been manifested in the roentgen diagnosis of calcification of the left auricle. Although only 19 cases have been recorded in the world literature, with a few additional scattered case reports in standard texts, it is our belief that this pathologic process is far more common than has been suggested (1–4)3. The purpose of this paper is to present two cases, with material which was studied during the training period of two of the authors, and to demonstrate the additional value of angiocardiography as a diagnostic tool in this condition. In all reported cases, a clinical or pathologic diagnosis of rheumatic heart disease was made. It was the original work of MacCallum (5, 6) which makes the pathologic anatomy so clear. He described a marked thickening of the wall of the left auricle above the base of the more posterior leaflet of the mitral valve. This is part of the general process of infiltration of the endocardium and subendocardium by inflammatory cells and Aschoff bodies. Ultimately, edema and necrosis make their appearance (7). More recent studies on the changes in the left auricle in rheumatic heart disease showed 24 of 178 auricles or their appendages (13 per cent) to contain thrombi (8). In no instance was a thrombus found in the right auricle, nor was the right auricle ever more involved pathologically than the left. In 4 hearts the deposits of calcium within the endocardium of the left auricle were conclusively visualized microscopically. This finding, however, is exceedingly rare on gross material. Auricular thrombosis was far more common in cases of auricular fibrillation. Although calcium can be deposited in many sites when associated with overdosage of vitamin D or abnormal calcium metabolism, this was not the case in any of the reviewed material (9). All cases were accompained by auricular fibrillation. Sosman (10) states that endocardial calcification can be found opposite a septal defect where the abnormal current strikes the endocardial surface. The location in such a case may be of diagnostic aid. There are no clinical findings that may be of assistance in the ultimate diagnosis. With the present expansion of cardiac surgery, however, careful roentgen evaluation is becoming more important. O'Farrell (11) reports a case which was discovered during the course of an attempted mitral valvulotomy; dense calcification of the left atrium prevented the completion of the operation. Careful examination of the films, in retrospect, revealed the calcifications. It has been suggested that changes take place within the auricle proper with auricular fibrillation that may in some way be responsible for the deposition of calcium salts (12). This does not appear likely, as these changes have as yet not been reported with auricular fibrillation secondary to cardiac disease other than rheumatic heart disease.