Heavy calcifications of the heart and vessels are easily detected by chest roentgenography, particularly in the lateral and oblique views (Fig. 12-25). Small calcifications, on the other hand, can be registered only by fluoroscopy by virtue of their rhythmic movements from the pulsating heart.3,8 Detection of even tiny coronary artery calcifications is of vital practical importance. The combination of chest pain and coronary calcification results from major vascular obstruction 94 percent of the time.!6 Since the major coronary arteries are embedded in the subepicardial fat stripes in the grooves between cardiac chambers (B+;Si Fig. 12-26), such fat stripes can be used effectively to locate the calcified arteries. Under the fluoroscope, the fat stripes present as pulsating radiolucent (bright) lines, in contrast to the accompanying pulsating radiopaque (dark) lines of calcified coronary arteries. If the artery coincides with the fat line within the left atrioventricular groove (aL), it portrays the circumflex coronary artery. The right coronary artery is moving synchronously with the right atrioventricular groove (aR). The anterior descending artery coincides with the anterior interventricular groove (vA), as does the posterior descending artery with the posterior interventricular groove (vP).
The lateral view is the best or the only view for detection of a calcified right coronary artery. The left anterior oblique view at 20 to 30° is the most suitable for localizing the bifurcation of the left coronary artery. In this view, the left coronary artery is brought into relief between the hilar shadow anteriorly and the spinal column posteriorly. A ringlike density is seen frequently in this view, representing the end-on image of the calcified anterior descending artery. The right anterior oblique angle is used to view a calcified left main coronary artery. If both the anterior descending and the circumflex branches are also calcified, a Y-shaped density may be seen. The calcified cardiac valves, the myocardium, and the pericardium are easily confirmed by fluoroscopy.2,29
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