Wednesday, March 24, 2010

Letter - Assessment of Atherosclerosis in Egyptian Mummies

Journal of the American Medical Association

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To the Editor: In their Research Letter, Dr Allam and colleagues described the presence of calcium hydroxyapatite in vessel walls in 15 of 22 ancient Egyptian mummies examined with whole-body 6-slice computed tomographic (CT) imaging. The authors stated that "[c]alcification in the wall of a clearly identifiable artery was considered diagnostic of atherosclerosis, and calcification along an artery's expected course was considered probable atherosclerosis." We believe that this criterion was incorrect.

When observing a vascular calcification on a CT (particularly 6-slice), it is not possible to distinguish lesions of atherosclerosis and mediacalcosis. Mediacalcosis is a thickening and loss of elasticity of the walls of arteries (particularly but not exclusively muscular ones) due to a calcification of the tunica media, the concentric layers of helically arranged smooth muscle cells. Such lesions may be seen in all the sites described in the article by Allam et al (abdominal aorta, aortic arch, popliteals, . . . [Full Text of this Article]

Philippe Charlier, MD, PhD
Department of Forensic Medicine and Pathology
University Hospital R. Poincaré (AP-HP, UVSQ)
Garches, France

Isabelle Huynh, MD
Department of Radiology
University Hospital Pitié Salpétrière (AP-HP)
Paris, France

And the reply . . .

Drs Charlier and Huynh propose that mediasclerosis is a unique disease, manifest as calcification of the tunica medica, a disease completely different from atherosclerosis, which they presumably would define exclusively as a disease of the intima. We believe that atherosclerosis is a multifaceted, systemic disease that encompasses both of these histologic features. The earliest pathologic manifestations of atherosclerosis include intimal thickening and fatty streaks, but complex changes occur as the disease progresses, with structural remodeling of the vessel, cellular infiltrates, lipid accumulation, thrombosis, fibrosis, and calcification involving the media as well as the adventitia.

Although mediasclerosis (also called Monckeberg sclerosis) has been attributed by some to a distinct disease process, others regard it as an advanced form of atherosclerosis, most commonly seen in patients with chronic kidney disease and diabetes. These patients often die from heart disease, another manifestation of the systemic disease of atherosclerosis. A distinct metabolic . . . [Full Text of this Article]

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