Dr. Pepe’s Diploma Casebook: Case 60 – SOLVED!

Dear Friends,

Today I am showing chest radiographs of a 78-year-old woman with moderate dyspnoea. Check the images below, leave your thoughts and diagnosis in the comments, and come back on Friday for the answer.


1. Mitral valve calcification
2. Pericardial calcification
3. Calcified ventricular aneurysm
4. None of the above



Click here for the answer

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    31 Responses to : Dr. Pepe’s Diploma Casebook: Case 60 – SOLVED!

    1. Nikhil says:

      Mitral valve calcification

    2. Maria says:

      What a great case!!! Even though i have never seen a calcified ventricular aneurysm on X-ray, i believe that is it. But i am worried about right lower lobe where seems to exist a lesion most prominent on profile image.

    3. mohammad alshafie says:

      Mitral annular calcification

    4. Francisco says:

      Calcificación severa anular Mitral. Me mosquea no ver un claro crecimiento auricular izquierdo.

    5. Quoc says:

      Answer 4.

    6. gus says:

      2. Pericardial calcification

    7. Adam says:

      Mitral valve (coarse, C-shaped) calcification . No signs of LV enlargement and LV aneurysm would be located anteriorly.
      Left posterior hemidiaphragm bulge (like in case 20) – needs further examination.

    8. mickaela says:

      1. Mitral valve calcification

    9. Akram says:

      Mostly 3: aneurysmal calcification

    10. Dr Ramesh K Pandey says:

      Dear Sir greetings..It looks like Mitral valvular calcification with Aortic knuckle calcification and changes of osteopenia

    11. Jonathan says:

      Looks like dense C-shape mitral annular calcification. Some nodularity to it makes me think there might be some focal superimposed caseous necrosis.

    12. Granchi. Bari. Italia says:

      …per le opzioni 2 e3 vi deve essere il raccordo anamnestico di una pregressa pericardite( con calcificazione più”sottile” ed a ” guscio”) o di un infarto del miocardio….una calcificazione di un aneurisma della coronarica,avrebbe un’ altra sede … Invece per forma e sede e’ più’ probabile che rappresenti l’esito di una necrosi caseosa , con calcificazione grossolana dell’ anulus , di una valvola mitralica.

    13. Albert says:

      Could it be liquefaction necrosis of mitral annulus?

      • Dr.Pepe says:

        As far as I know, the appearance of casseous necrosis in the plain film has not been described in the literature.
        I have collected six cases (which makes me the world’ expert 😉 ) and all of them have a rounded appearance, instead of being C-shaped.

    14. Swapni says:

      Calcified Ventricular aneurysmal

    15. Bipin Daga says:

      Mitral valve calcification

    16. Genchi. Bari. Italia says:

      …..errata corrige : Genchi bari italia( non granchi)

      • Genchi. Bari. Italia says:

        ….dovresti spiegarci perché’ la necrosi caseosa e successiva calcificazione interessa solo la valvola mitrale e non le altre valvole cardiache?Grazie…

        • Dr.Pepe says:

          I don´t know. May be due to the anatomy of the chordae tendinae of the mitral valve. There are several articles about this condition. Will look it up and get back to you.

    17. Dr.Pepe says:

      At this time of the week I believe it is correct to give the right answer: the appearance is practically pathognomonic of calcified mitral annulus.

      Congratulations to Mohammad Alshafie, who was the first to mention the right diagnosis.

    18. Mohammed Atea Ahmed says:

      Mitral valve calcification.