Arterial Intima and Media Calcification

Medical students have been taught since more than 100 yr that there are at least two types of pathologic calcium phosphate deposition in the arterial wall, namely, intima calcification and media calcification. The medical community has become used to making this distinction since the initial description, in the year 1903, by the German pathologist Johann Georg Monckeberg, at Strasbourg University Medical School, of arterial media calcification, a disease entity called after him “Monckeberg’s mediasclerosis” or “Monckeberg’s mediacalcinosis” (1). Since then, this type of calcification has been considered to be different from that of the intima. In the latter, calcium phosphate crystals are located within the cholesterol-rich lesions characteristic of atherosclerosis.Did Monckeberg get it wrong? This challenging hypothesis has recently been formulated by McCullough (Divisions of Cardiology, Nephrology, Nutrition, and Preventive Medicine, William Beaumont Hospital, Royal Oak, MI; personal communication, October 3, 2007) at a meeting of experts in the bone and mineral disorder associated with chronic kidney disease, to the surprise of the other members of the workgroup. Clearly, modern tissue staining techniques and cellular and molecular tools developed for the analysis of normal vessel wall structure and its changes in various disease states were not available to pathologists at the start of the 20th century. Moreover, it is not easy to get rid of established definitions and classifications, let alone dogmas, all of the more when they are more than 100 yr old. Let us not forget that to break dogmas an open-minded spirit is an important prerequisite as well. We all have in mind long-lived dogmas in medicine, …