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A 49 year old man with a history of tuberculosis during childhood was referred to our department for a routine check up. The chest radiograph (left panel) showed circumferential calcification of the heart (arrows). Subsequently performed ECG gated multislice computed tomography (right panel) confirmed pericardial calcifications (arrows) surrounding nearly the entire heart without involving the coronary arteries (asterisk). The left ventricular ejection fraction was estimated to be normal by computed tomography and transthoracic echocardiography (to view video footage visit the Heart website—http://www.heartjnl.com/supplemental). Different causes of pericardial calcifications have to be considered: tuberculosis, radiation therapy, trauma, uraemia, and viral infections. In the patient presented here the episode of tuberculosis during childhood is the most likely cause of the armoured heart.
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