To the Editor: In their Research Letter, Dr Allam and colleagues1 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.2 Such lesions may be seen in all the sites described in the article by Allam et al (abdominal aorta, aortic arch, popliteals, peroneals, superficial femoral artery, anterior tibial, and iliac).2 It is also surprising that no presumed atherosclerosis calcification was found in supra-aortic arteries, especially carotid, a common site of such lesions.3
The development of vascular calcification is related not only to atherosclerosis.4 Other conditions may lead to the formation of such lesions, including aging, diabetes, disorders of calcium-phosphorus metabolism, chronic microinflammation, hyperhomocysteinemia, and chronic renal insufficiency.3 Moreover, given the poor state of preservation of the organic tissues, a differential diagnosis for the findings should include parasitic calcifications in lymphatic vessels (particularly from filariasis).
Research in bioarchaeology and forensic pathology indicates that only a microscopic examination allows a precise diagnosis for human in situ calcifications.5 Conclusions reached without histological confirmation may be erroneous.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.