Learning Radiology xray montage

Calcification of the Left Atrial Wall

General considerations

  • Calcification of left atrium relatively common finding in patients with long-lasting rheumatic valve disease
  • Massive calcification of the left atrial walls (porcelain atrium) is rare condition with implications for mitral valve surgery (see below)
  • Massive calcification of the left atrium predominantly affects women (3/4 of cases)
  • Almost always associated with rheumatic mitral stenosis
  • Most patients have experienced long-term symptoms (more than 15 years)
  • Most patients have previously undergone mitral valve operations

Almost all have atrial fibrillation

  • With an average duration of 10 years


  • Usually spares the interatrial septum

Patterns of calcification

  • Type A
    • Calcification in the left atrial appendage only
    • Underlying lesion is most commonly mitral stenosis
    • Almost always associated with thrombus in the appendage
  • Type B
    • Free wall of the left atrium and mitral valve are calcified
    • Indicates advanced mitral stenosis
  • Type C
    • Small area of calcification is confined to the posterior wall of the LA
    • Results from a jet lesion because of mitral regurgitation
    • Called a McCollum patch


  • Surgical technique during interventions for valvular substitution are difficult with calcification of the wall
  • Dislodgement of thrombus from the left atrium during surgery can result in cerebral embolism and uncontrollable hemorrhage if the left atrium is entered through the calcified region
    • This is because of wall rigidity
  • Endarterectomy with mitral valve replacement is the currently accepted corrective procedure 

 Calcification of left atrial wall

Calcification of left atrial wall in long-standing mitral stenosis. Upper photo: The left atrium (black arrows) is located in the center of the heart posteriorly. The anterior wall of the left atrium is calcified in this photo (see inset in lower photo), a finding usually found in patients with chronic mitral stenosis who have already had atrial fibrillation and a mitral valve replacement. There is a prosthetic mitral valve present (blue arrows). The patient had mitral stenosis for 23 years.


Coconut Atrium: Transmural Calcification of the Entire Left Atrium. Carlos Del Campo, MD, Paul Weinstein, MD, Constantine Kunnelis, MD, Peter DiStefano, RDCS, RVT,* and Gloria M. Ebers, RT, CVT* Texas Heart Institute J. 2000; 27(1): 49–51. Copyright 2000 by the Texas Heart® Institute, Houston 

eMedicine  Cardiac Calcifications. Sohail G Contractor, MD with Pierre D Maldjian, MD, Mysore Seetharaman, MD, Hani H Abu-Judeh, MD, Farid Thanawala, MD