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Extreme vascular calcification 40 years after radiotherapy in childhood.

A 49-year-old man with no cardiovascular disease risk factors was admitted to our emergency department with stable angina and shortness of breath on exertion for the last 3 months. The patient had a medical history of Hodgkin lymphoma, treated with 45-Gy mediastinal irradiation at the age of 9 years old. On physical examination, he has a regular pulse, blood pressure of 125/80 mmHg and crackles in both lung bases. Electrocardiography showed pathologic Q waves in II, III and aVF leads, and the echocardiography revealed mildly depressed systolic left ventricular function and inferior wall akinesia. Coronary angiography demonstrated heavy aortic root calcification, ostial chronic right coronary artery occlusion, severe and heavily calcified left main lesion and internal mammary artery atresia (Fig. 1b–e). In order to consider cardiac surgery, a computed tomography angiogram was performed and it confirmed the extreme mediastinal structures calcification (Fig. 1a). Finally, due to the high risk of open-heart surgery, left coronary angioplasty with a drug-eluting stent was successfully performed.