Affiliations: Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan | Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan | Department of Biotechnology, Yuanpei University, Hsin Chu, Taiwan
Note:  Corresponding author: Prof. Shan-Yang Lin, PhD, Department of Biotechnology, Yuanpei University, No. 306, Yuanpei street, Hsin Chu, 30015 Taiwan. E-mail: email@example.com.
Abstract: Soft tissue calcification has been linked to many disease states. Differences in the chemical composition of calcifications not only aid in the understanding of disease onset and progression but also help in correlating with the pathogenesis. A rare case of a huge intra-cardiac calcified lesion within the left atrium of heart was diagnosed in an 80-year-old male patient. Chest CT and X-ray screening, morphological observation, histopathological examination, and Raman spectral analysis of this giant cardiac calculus were investigated. Both chest CT and X-ray images showed a huge lesion with an obvious calcified ring and a shadow that almost completely occupied the left atrium of the heart. The histopathological examination revealed deep blue–purple (H&E) and black (von Kossa) stains of calcium salts interspersed within the non-calcified tissue. Morphologically, this giant cardiac calculus was a hard, brownish-yellow, fist-shaped calculus (about 50×45×30 mm in size) surrounded by a layer of thick white tissue. The brownish-yellow areas on the encrusted surface of the cardiac calculus had a high level of calcium hydroxyapatite after portable Raman spectroscopic detection, but the cholesterol component was predominant in the layer of firm white tissue. Some type-B carbonate apatites and proteins were also identified. The portable Raman spectroscopy with a fiber-optic probe evidenced that this giant cardiac calculus was composed of cholesterol, calcium hydroxyapatite, type-B carbonate apatite and protein.