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IMAGES IN VASCULAR SURGERY
Year : 2015  |  Volume : 2  |  Issue : 2  |  Page : 84-85

Warfarin - induced Tracheobronchial Calcification


1 Department of Medicine, Dr. R. M. L. Hospital, New Delhi, India
2 Department of Medicine, Medical College, Kolkata, India

Date of Web Publication31-Jul-2015

Correspondence Address:
Dr. Krishnarpan Chatterjee
Department of Medicine, Dr. R. M. L. Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-0820.161950

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  Abstract 

Tracheobronchial calcification can be seen normally in the elderly. Warfarin therapy leads to calcification at an early age. We present a 35-year-old man whose chest X-ray showed prominent calcification.

Keywords: Tracheobronchial calcification, warfarin, oral anticoagulants


How to cite this article:
Chatterjee K, Sen C. Warfarin - induced Tracheobronchial Calcification. Indian J Vasc Endovasc Surg 2015;2:84-5

How to cite this URL:
Chatterjee K, Sen C. Warfarin - induced Tracheobronchial Calcification. Indian J Vasc Endovasc Surg [serial online] 2015 [cited 2019 Aug 22];2:84-5. Available from: http://www.indjvascsurg.org/text.asp?2015/2/2/84/161950

A 35-year-old man presented to us with a history of sudden onset weakness of left side of body and deviation of mouth to right side for 1-day. He was a known case of rheumatic heart disease with mitral regurgitation, pulmonary hypertension, and atrial fibrillation. He had been on oral warfarin 5 mg once daily for the past 5 years for stroke prophylaxis. On examination, he had an irregularly irregular pulse. He had a dense left hemiplegia with upper motor neuron type of left facial palsy. At the apex, he had a grade 4 pansystolic murmur with grade 2 left parasternal heave and loud P 2 . His international normalized ratio was 1.6 which was below the therapeutic range. Plain computed tomography head showed infarct in the right middle cerebral artery territory. Chest X-ray showed cardiomegaly, prominent descending pulmonary artery, and extensive calcification of the tracheobronchial tree [Figure 1] and [Figure 2]. Echocardiography showed enlarged left atrium with thrombus in left atrial appendage.
Figure 1: Cardiomegaly with prominent descending right pulmonary artery

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Figure 2: Extensive tracheobronchial calcification

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Calcification of the tracheobronchial tree is normally seen in the elderly, especially women. It has also been reported in young patients on long-term warfarin therapy. The association was first proposed by Taybi and Capitanio by reporting three children who were on warfarin after mitral valve replacement. [1] This association was later confirmed by Moncada et al. [2] The putative mechanism may be due to the inhibition of normal production of a Vitamin K dependent protein that inhibits calcification. This finding does not necessitate stopping warfarin therapy.

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Taybi H, Capitanio MA. Tracheobronchial calcification: An observation in three children after mitral valve replacement and warfarin sodium therapy. Radiology 1990;176:728-30.  Back to cited text no. 1
    
2.
Moncada RM, Venta LA, Venta ER, Fareed J, Walenga JM, Messmore HL. Tracheal and bronchial cartilaginous rings: Warfarin sodium-induced calcification. Radiology 1992;184:437-9.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]


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