Unusual 'Tick Mark' Calcification on Chest Radiograph in Rheumatic Heart Disease - CT Imaging Revealing Pericardial Calcification.

The identification and the interpretation of subtle opacities on chest radiographs are challenging for clinicians. At times, especially when they are found incidentally, some opacities may be considered as artefacts or insignificant and they are neglected. In the present case, an unusual 'tick mark' - shaped dense opacity was incidentally found over the cardiac shadow, and CT imaging revealed pericardial calcification. Pericardial, valvular and atrial calcifications in rheumatic heart disease have been described in the literature.