An 85-year-old man presented for cardiac evaluation before urological surgery with a long history of intermittent stiffness and discomfort in the dorsal spine. An early diastolic murmur (grade II/VI) was heard along the left parasternal border. The sedimentation rate was 91 mm in the first hour. A, Posteroanterior chest x-ray shows mild cardiac enlargement with prominence of aortic knob and left ventricle. B, Lateral chest x-ray (focused) shows ossification and calcification of the anterior longitudinal ligament (long arrows); when bridging the adjacent vertebrae, the ligament imparted to the spine the classic “bamboo” appearance (short arrows). Squaring of the vertebral bodies and osteoporosis are also evident. C, ECG shows complete right bundle-branch block. D, Parasternal long-axis echocardiogram: “subaortic bump” represents fibrosis at the mitral-aortic junction (arrowhead); also evident is thickening of the walls of the aortic root and left septal endocardium (arrows). E, Parasternal short-axis echocardiogram shows thickened aortic root and valve cusps (AV). F, Color-flow Doppler demonstrates aortic regurgitation jet (ARJ) and disturbed blood flow in diastole (mosaic color) below aortic valve orifice (AO) extending into left ventricular cavity (LV). LA indicates left atrium.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC 4-265, Houston, TX 77030.
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