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Weekly Chest CasesArchive of Old Cases

Case No : 927 Date 2015-08-03

  • Courtesy of Ji-Eun Choi, MD., Woon-Jung Kwon, MD. / Ulsan University Hospital
  • Age/Sex 62 / F
  • Chief ComplaintAbnormalities detected on routine check up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Nodular pulmonary amyloidosis
Radiologic Findings
Chest PA shows scattered, distributed, ill-defined, small pulmonary nodules in both lungs. Chest CT shows multiple, thin-walled, round cysts and relatively well-defined pulmonary nodules in both lungs. Some cysts contain small pulmonary nodules and some nodules contain amorphous calcifications.
Brief Review
Amyloidosis is a systemic disease caused by extracellular accumulation of amyloid substances. Amyloid deposition can occur in the lung in the setting of primary or secondary systemic diseases. It appears in the lung in 30%–90% of primary systemic amyloidosis cases, and secondary amyloidosis can occur with a host of chronic inflammatory diseases (e.g., collagen disease such as RA). Three histopathologic types of pulmonary amyloidosis are present: submucosal tracheobronchial deposits, diffuse interstitial deposits, and single or multiple pulmonary nodules.
Nodular amyloidosis is almost always localized to the lungs. The nodules usually are concentrated in the lower lobes and are typically subpleural or in the peripheral space. They vary in shape and size (range, 0.5–15.0 cm). Calcification or ossification is seen in up to 50% of cases. In rare instances, nodular amyloid deposits may be associated with cysts, but their relationship is unclear. Nodular amyloidosis associated with thin-walled cysts is most common in patients with Sjogren syndrome.
Please refer to
Case 277, Case 379, Case 608, Case 786, Case 900,
References
1. Pulmonary amyloidosis with calcified nodules and masses-a six-year computed tomography follow-up: a case report Cases J 2009;2:6540
2. Nodular pulmonary amyloidosis Jpn J Thorac Cardiovasc Surg 2006;54:399–401
3. Pulmonary Amyloidosis Radiology 2012;263:929-932
Keywords
Lung, Metabolic and storage lung disesae,

No. of Applicants : 72

▶ Correct Answer : 50/72,  69.4%
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Kyoto University , Japan Akihiko Sakata
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - GHICL , France manuel toledano
  • - University of British Columbia , Canada Amr Ajlan
  • - CHRU Lille , France Julien Pagniez
  • - himeji redcross hospital , Japan souichirou okamoto
  • - Armed Force Seoul Hospital , Korea (South) Eui Jin Hwang
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - MEDANTA- THE MEDICITY , India JAYANT VISHAL
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Ajou University hospital , Korea (South) Hun Cho
  • - Asan , Korea (South) Sania ALBlushi
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - Wuhan Union Hospital , China Qiguang Cheng
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Niigata University , Japan Atsushi Uehara
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - IRSA La Rochelle , France Denis Chabassiere
  • - okayama university , Japan numa shingo
  • - CHU Poitiers , France CHAN paul
  • - CLCC Rennes , France nicolas gautier
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Himeji Red Cross Hospital , Japan Mayu Uka
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - Santosh hospital,Bengaluru , India Pravin Mahadevappa
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 3/72,  4.2%
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
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