Fleckenstein’s hypothesis revisited: excessive myocardial calcification after prolonged high dose catecholamine treatment: a case report

Figure 1. Total doses of norepinephrine in mg/24 h (bars) and course of systolic and diastolic blood pressure (blue lines) and heart rate (red line) over time.

Figure 2. Initial contrast-enhanced computed tomography of the thorax (A) demonstrating a normal density of the left ventricular myocardium. At that time pulmonary embolism was demonstrated. On corresponding follow-up computed tomography scans 2 weeks (B) and 2 months later (C) the left ventricular myocardium depicts markedly hyperdense areas at the apex and the lateral wall suggestive of diffuse calcifications (arrowheads).

Figure 3. Cardiac magnetic resonance imaging (A and C) and computed tomography (B and D) acquired with ECG synchronization. On T2-weighted STIR images in three-chamber view (B) the left ventricular myocardium shows a normal signal intensity without signs of myocardial oedema. T1-weighted inversion-recovery sequences in short-axis orientation (C) after intravenous application of contrast show a marked late gadolinium enhancement of the anterior and anterolateral aspects of the left ventricular wall (arrowheads). B and C display corresponding multiplanar reconstructions in three-chamber view and short-axis orientation of the unenhanced cardiac computed tomography scan with ECG synchronization. Note again the markedly hyperdense depictions of the left ventricular wall corresponding to diffuse calcifications.

Figure 4. Histology in Masson Trichrome staining showing replacement of ventricular myocardium by calcificated components.