Images in Clinical Medicine
Pericardial Calcification Noted Long after Sydenham's Chorea
N Engl J Med 2009; 361:1386October 1, 2009
- Article
A 76-year-old native Dutch woman was admitted to our intensive care unit for hemodynamic monitoring after undergoing vulvectomy and inguinal lymph-node dissection for vulvar carcinoma. Preoperative evaluation had revealed a history of deep venous thrombosis, type 2 diabetes mellitus, and atrial fibrillation, with a slightly reduced tolerance for exercise (New York Heart Association functional class II) and peripheral edema. There was no known history of mitral-valve disease and no murmur on examination. Previous cataract surgery and drainage of a subdural hematoma had been performed with no complications. Two chest radiographs (Panels A and B) and a computed tomographic scan (Panel C) revealed extensive pericardial calcification. The patient had no history of infection with tuberculosis, but in childhood she had had Sydenham's chorea. Also known as St. Vitus's dance or chorea minor, Sydenham's chorea is a self-limited, autoimmune-mediated, choreiform movement disorder that follows infection with Streptococcus pyogenes. In this case, we suspect that pericardial calcification resulted from an earlier bout of rheumatic fever.
R. Arthur Bouwman, M.D., Ph.D.
Rob J.M. Strack van Schijndel, M.D.
VU University Medical Center, Amsterdam, the Netherlands
a.bouwman@vunc. nl
