Case report finds os cordis in a 39-year-old man with cardiac disease — Evidence Review
Published by researchers at National University of Avellaneda
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Table of Contents
A recent case report describes the discovery of a rare, boomerang-shaped bone structure—os cordis—in the heart of a 39-year-old man, a finding seldom reported in humans. Related studies generally align with the possibility of such structures in human and nonhuman hearts, though there is ongoing debate regarding their prevalence and composition, with some experts suggesting these features may be more common than previously appreciated (National University of Avellaneda).
- Prior research has established the presence of os cordis and similar cartilaginous or bony structures in the hearts of nonhuman mammals (such as cows and camels), and, more recently, in great apes and a small number of human cases, often in association with cardiac disease or tissue scarring 1 2 3 4.
- The new case supports earlier findings that these structures may develop in response to cardiac pathology, aligning with studies in chimpanzees where os cordis was found exclusively in hearts affected by myocardial fibrosis 1 3.
- There remains disagreement regarding whether the os cordis and the so-called “cardiac fulcrum” described by other investigators are the same entity, with differences noted in tissue composition (bone versus cartilage/tendon) and age-related changes 3.
Study Overview and Key Findings
Interest in rare cardiac structures has grown following the incidental identification of bone-like tissue in the heart during autopsies. This study is notable for identifying a true os cordis—a small, bean-sized bony formation—within the heart of a relatively young adult who also had evidence of cardiac disease. The case is significant because such structures were previously thought to be exceedingly rare or absent in humans, though they are well documented in other mammals. The detailed dissection and histological analysis undertaken in this case reveal the potential for overlooked anatomical features during standard autopsies, prompting reconsideration of the prevalence and significance of os cordis in human health and disease.
| Property | Value |
|---|---|
| Organization | National University of Avellaneda |
| Authors | Dr. Jorge Trainini |
| Population | 39-year-old man with cardiac disease |
| Methods | Case Report |
| Outcome | Presence of os cordis in human heart |
| Results | Os cordis found in a 39-year-old man, a rare cardiac structure. |
Literature Review: Related Studies
To place this case in context, we searched the Consensus database of over 200 million research papers. The following queries were used to identify relevant studies:
- os cordis cardiac anomaly
- rare cardiac structures autopsy findings
- 39-year-old man heart anatomy case study
Summary Table of Key Themes and Findings
| Topic | Key Findings |
|---|---|
| What is the prevalence and anatomical nature of os cordis and similar cardiac structures? | - Os cordis is commonly found in nonhuman mammals (e.g., ruminants, camelids) and has recently been identified in great apes and rare human cases 1 2 3 4. - There is variability in location, composition (bone, cartilage), and prevalence by species and age 1 2 3 4. |
| How are cardiac bone/cartilage structures linked to cardiac disease or aging? | - The formation of os cordis or cartilago cordis is often associated with cardiac pathology, such as fibrosis, atherosclerosis, or cardiomyopathy 1 3. - Age and disease are significant factors influencing the presence and development of these structures 3 4. |
| What are the proposed functions and clinical implications of these structures? | - Os cordis may aid in stabilizing the heart, supporting cardiac valves, or counteracting mechanical stress 2 3 4. - Their presence may influence electrical conduction and be linked to arrhythmia risk or sudden cardiac death in susceptible individuals 1 3. |
| How are rare cardiac findings identified and interpreted in autopsy practice? | - Unusual cardiac structures may be underreported due to standard autopsy protocols not including detailed dissections of key areas 3 7. - Accurate interpretation of rare cardiac findings is essential to avoid diagnostic errors in sudden cardiac deaths 7 9. |
What is the prevalence and anatomical nature of os cordis and similar cardiac structures?
Recent studies highlight that os cordis and related structures are more common in nonhuman mammals but have also been observed in great apes and a limited number of human cases, particularly when advanced imaging or thorough histological examination is employed. The anatomical characteristics of these structures vary significantly between species, and even among individuals, with some being composed of bone, others of cartilage or mixed tissue types 1 2 3 4.
- Os cordis is routinely documented in cattle, camels, and some other mammals, and has recently been found in three out of sixteen chimpanzee hearts, all with cardiac fibrosis 1 2.
- In humans, reports remain rare, but the presence of bone or cartilage in the heart has now been described in several autopsy studies, with some evidence suggesting age or disease-related changes in tissue composition 3.
- Composition ranges from trabecular bone with marrow spaces to cartilage and calcified tissue, depending on species and individual history 2 4.
- Anatomical location typically includes the fibrous skeleton of the heart, particularly near valve rings and the atrioventricular plane 2 4.
How are cardiac bone/cartilage structures linked to cardiac disease or aging?
The development of os cordis and related structures appears closely tied to underlying cardiac pathology and the aging process. In animal studies and recent human reports, these formations are more likely to appear in hearts with myocardial fibrosis, atherosclerosis, or other chronic diseases 1 3 4.
- All chimpanzees with os cordis in one study had significant myocardial fibrosis and no healthy heart showed such structures 1.
- In camels, the amount of calcified cartilage and bone in the os cordis increases with age and is thought to reflect cumulative mechanical stress 4.
- In humans, both age and disease (such as cardiomyopathy or coronary artery disease) may promote the formation or persistence of these structures, which may start as bone and transition to cartilage with aging 3.
- The current case, involving moderate atherosclerotic disease, fits this pattern of disease-associated os cordis development 3.
What are the proposed functions and clinical implications of these structures?
Although their exact role remains speculative, several functions have been proposed for os cordis and related formations, including providing structural support to the heart, reinforcing the cardiac skeleton, and influencing electrical conduction pathways 2 3 4.
- The os cordis may stabilize the heart’s structure, particularly the valve rings, to help resist mechanical forces during contraction 2 3.
- In some species, these structures are hypothesized to protect conduction system components or modulate stress at the atrioventricular junction 2 3 4.
- Their presence in disease states has raised concerns about disruption of electrical conduction, with a potential link to arrhythmias or sudden cardiac death, especially when found near the atrioventricular node 1 3.
- The clinical significance in humans remains uncertain, but the possibility of overlooked impacts on heart rhythm or function warrants further study 1 3.
How are rare cardiac findings identified and interpreted in autopsy practice?
Detection of rare cardiac structures depends heavily on the extent and focus of the autopsy. Standard practices may miss subtle or small anatomical variations unless specific, detailed dissection protocols are followed. The interpretation of such findings also carries implications for cause-of-death determinations and family counseling 3 7 9.
- In the present case, the os cordis was found after targeted dissection of the atrioventricular node and surrounding tissue, a step not typically included in routine autopsies 3.
- Other studies emphasize that rare findings of uncertain significance can lead to misdiagnosis or confusion if not cautiously interpreted in the context of the full clinical and pathological picture 7 9.
- There is broad agreement in the literature that improved standardization and awareness of potential rare cardiac structures could enhance diagnostic accuracy in forensic and clinical settings 3 7 9.
- The frequency of overlooked or mischaracterized structures such as os cordis in standard autopsy practice remains unknown 3.
Future Research Questions
The identification of os cordis in a human heart raises several important questions about its prevalence, development, and clinical implications. Further research is needed to determine how common these structures are in the general population, what circumstances promote their formation, and whether they have measurable effects on cardiac function or disease risk.
| Research Question | Relevance |
|---|---|
| What is the true prevalence of os cordis and cardiac fulcrum structures in the general human population? | Determining prevalence requires systematic autopsy studies with detailed histological analysis, as standard protocols may underestimate these findings 3. A better understanding of how common these structures are could clarify their role in health and disease 1 3. |
| How do age and underlying cardiac disease influence the formation and composition of os cordis in humans? | Animal and limited human studies suggest that aging and cardiac pathology are key factors in the development of os cordis, which may start as bone and transition to cartilage 1 3 4. Understanding these processes may inform risk assessment and improve disease models. |
| Are os cordis and cardiac fulcrum distinct structures, or variations of the same anatomical feature? | There is ongoing debate about whether these terms describe the same entity or different features based on composition and age; resolving this could standardize terminology and clarify anatomical classification 3. |
| Does the presence of os cordis influence electrical conduction and arrhythmia risk in humans? | Evidence from animal models suggests a potential link between os cordis and arrhythmias 1, but human data are lacking. Clarifying this relationship may have implications for diagnosing and managing sudden cardiac death 1 3. |
| What are the best practices for detecting rare cardiac structures during autopsy? | Improving autopsy protocols and increasing awareness of such anatomical variants could lead to more consistent identification and reporting, reducing diagnostic uncertainty and improving understanding of their clinical importance 3 7 9. |