Significance of Calcification of the Wall of the Left Atrium

Calcification of the wall of the left atrium was first reported by Shanks, Kerley, and Twining in 1938 (6). Since that time, only 31 cases have been reported. Although intramural calcification of the left atrium is primarily a radiological diagnosis, this concept has not been presented to the readers of this journal. It is believed that this lesion is more common than has been manifested by the published reports. In adding 2 new cases to the 31 reported in the literature, the importance of recognizing calcifications of the left atrium will be stressed, particularly in those cases in which some surgical procedure upon the heart is contemplated. Calcification of the left atrium is found in patients who have suffered from extensive rheumatic carditis and long standing valvular disease. It is believed that the calcification of the wall of the left atrium represents the site of the carditis. Many of these patients suffer from both mitral stenosis and insufficiency and most of them have involvement of other valves as well as the mitral valve. The pathological findings are chiefly subendocardial plaque formation, endocardial fibrosis, connective-tissue hyperplasia, and Aschoff nodule formation. It appears that the site of predilection for the endocarditis is on the posterior wall of the atrium above the mitral valve. The extent of the auricular lesion is usually related to the severity of the valvular disease. Ruskin and Samuel (11) have reviewed and summarized the cases of this disease which have been reported in the literature and have added two cases of their own. They find that the average age of the patients with calcification of the wall of the left atrium is fifty-one years. The average length of time which these people have suffered from rheumatic heart disease has been twenty-nine years. Most of the patients have had symptoms for seventeen years or more. A calculation of the concomitant complications in a person with extensive calcification of the left atrium revealed the incidence of auricular fibrillation to be ten years. Congestive heart failure occurred in 80 per cent, and the average duration of congestive failure was eleven years. Hypertension was found in 10 per cent of the patients. The average age at death was fifty-three years. The diagnosis of calcification of the left atrium frequently can be made on a plain chest film. Slightly overexposed Bucky films of the chest, body-section studies through the left atrium, or roentgen cinematography may be needed to confirm the diagnosis. Soloff, Zatuchni, and Fisher (12) stress the importance of planigraphy and report 2 cases of calcification of the left atrial wall discovered in this way that were totally unsuspected in routine projections of the chest. Moderate amounts of calcium can always be identified on chest films of good technical quality, although the anatomical site and pathological process may not be as readily apparent.