대한흉부영상의학회 Weekly Chest Cases

Case No : 939 Date 2015-10-26

Courtesy of Jeong Min Ko, Hyun Jin Park / St. Vincent’s hospital, The Catholic University of Korea
Age/Sex 54 / F
Chief ComplaintIncidentally detected abnormality on routine chest radiograph

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Diagnosis With Brief Discussion

Diagnosis: Amyloidosis
Radiologic Findings: Chest radiograph shows mottled or nodular increased opacities with calcifications in the right lower and left upper lung zones.
Chest CT scans demonstrate multifocal peripheral nodular calcifications and multiple thin walled cysts in both lungs.
After VATS wedge resection, pulmonary amyloidosis was confirmed. Then, the patient was also diagnosed with Sjögren’s syndrome.
Brief Review: Amyloidosis is a disease characterized by the deposition of abnormal proteins in extracellular tissue. Clinically there are three broad classifications of pulmonary involvement: (1) diffuse or alveolar septal, (2) localized nodular, and (3) tracheobronchial amyloidosis.
Amyloid nodules in the lung parenchyma are usually an incidental finding that need to be distinguished from neoplasia. They are usually peripheral and subpleural, occur more frequently in the lower lobes, may be bilateral, and range in diameter from 0.4 cm to 15 cm.
Rarely, nodular or diffuse pulmonary amyloidosis may present with thin walled cysts. Amyloid–associated cystic lung disease is usually associated with AL amyloidosis and can occur in patients with or without underlying connective tissue disease (especially Sjögren's syndrome).
Please refer to
References: 1. Utz JP, Swensen SJ, Gertz MA. Pulmonary amyloidosis. The Mayo Clinic experience from 1980 to 1993. Ann Intern Med. 1996, 124(4):407-13.
2. Gillmore JD, Hawkins PN. Amyloidosis and the respiratory tract. Thorax. 1999,54(5):444-51.
3. Lantuejoul S1, Moulai N, Quetant S, et al. Unusual cystic presentation of pulmonary nodular amyloidosis associated with MALT-type lymphoma. Eur Respir J. 2007, 30(3):589-92.
4. Zamora A, White D, Sykes AM, et al. Cystic lung disease with pulmonary amyloidosis: Analysis of 21 patients. Eur Respir J. 2014, 44(Suppl 58); 716.
Keywords: Lung, Metabolic and storage lung disesae,

No. of Applicants : 85

▶ Correct Answer : 50/85, 58.8%

- Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
- Juntendo University Hospital , Japan Akifumi Hagiwara
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Asan Medical Center , Korea (South) Hyung Jung Koo
- University of British Columbia , Canada Amr Ajlan
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Ajou University Hospital , Korea (South) Seulgi You
- Hanyang University Guri Hospital , Korea (South) Seung Hyun Kim
- Kyoto University , Japan Akihiko Sakata
- Hallym University Kangnam Sacred Heart Hospital , Korea (South) Jung Youn Kim
- Asan Medical Center , Korea (South) Jooae Choe
- McGill University Health Center , Canada Alexandre Semionov
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Niigata City General Hospital , Japan Takao Kiguchi
- Otsu Red Cross Hospital , Japan Hirotsugu Nakai
- University of Tsukuba Hospital , Japan Sodai Hoshiai
- �stanbul , Turkey Ayhan Yilmaz
- Onomichi municipal hospital , Japan Hirofumi Mifune
- the first affiliatited hospital of nanjing medical univercity , China Hai Xu
- Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Shiga University of Medical Science , Japan Akitoshi Inoue
- , Korea (South)
- Gyoda Sogo Hospital , Japan Mihoko Yamazaki
- Ajou University Hospital , Korea (South) Taeyang Ha
- Ajou University Hospital , Korea (South) Young Keun Sur
- Ajou university hospital , Korea (South) Pae Sun Suh
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- , Korea (South) BAEK YOOLIM
- Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
- Asan Medical Center , Korea (South) Soyeoun Lim
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- IRSA La Rochelle , France Denis Chabassiere
- CHU Poitiers , France CHAN paul
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Fortis hospital , Mohali , India Shaleen Rana
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Santosh hospital,Bengaluru , India Pravin Mahadevappa
- CNUH , Korea (South) Kim Jung
- Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Kizawa Memorial Hospital , Japan Shoji Okuda
- Gifu Central Hospital , Japan Haruo Watanabe
- Nasaret Hospital , Korea (South) Hee Seok Choi

▶ Correct Answer as Differential Diagnosis : 11/85, 12.9%

- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- GHICL , France manuel toledano
- Centre Hospitalier Regional de Lanaudiere , Canada Matthieu Storme
- Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Niigata University , Japan Atsushi Uehara
- CLCC Rennes , France nicolas gautier
- Asan , Korea (South) Sania ALBlushi
- Chonnam national university hospital , Korea (South) INSOO JANG
- Busan national univercity hospital radiology department , Korea (South) Il-wan Son
- Medicheck health care , Korea (South) Chae Lim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 939 Date 2015-10-26

Discussion

No. of Applicants : 85