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Weekly Chest CasesArchive of Old Cases

Case No : 1028 Date 2017-07-10

  • Courtesy of Sung Shick Jou, Kim Young Tong / Soonchunhyang University Cheonan Hospital
  • Age/Sex 55 / F
  • Chief ComplaintIncidental abnormality on low dose chest CT
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Tracheobronchial amyloidosis in a patient with RA
Radiologic Findings
On lung setting images of low dose chest CT, nodular lesions with irregular wall thickening are noted in the trachea, resulting in the narrowing of the airway. Those lesions spare the membranous portion of the trachea. Multiple bullae are noted in the upper lobes. On mediastinal setting images, those lesions contain calcifications. Diffuse airway narrowing with nodularity is also noted on virtual bronchoscopy. On bronchoscopy, whitish nodular lesions with diffuse luminal narrowing of trachea and bronchi were seen.
Brief Review
Amyloidosis is a disease characterized by extracellular deposition of insoluble fibrillar protein in various organs. Various forms of amyloidosis in the chest exist: nodular parenchymal amyloidosis, diffuse alveolar septal amyloidosis, airway amyloidosis, mediastinal amyloidosis, and cardiac amyloidosis. In primary amyloidosis, amyloid light chain (AL) is derived from the abnormal breakdown of immunoglobulin light chains. In secondary amyloidosis, the deposited protein is serum amyloid A (AA) , which is an acute-phase reactant noted in systemic infections and inflammatory disorders such as rheumatoid arthritis, chronic bronchitis, and osteomyelitis. Tracheobronchial amyloidosis occurs more often in a localized form. On CT, long segmental narrowing of the tracheobronchial lumen with wallthickening, nodules, or plaques are noted. Calcification or ossification of the involved airway is seen. Amyloidosis may involve the tracheal posterior membrane, unlike tracheobronchopathia osteochondroblastic or relapsing polychondritis, which spare the posterior membrane.
References
1. Czeyda-Pommersheim F, Hwang M, Chen SS, Strollo D, Fuhrman C, Bhalla S. Amyloidosis: Modern Cross-sectional Imaging. Radiographics. 2015 Sep-Oct;35(5):1381-92.
2. Aylwin AC1, Gishen P, Copley SJ. Imaging appearance of thoracic amyloidosis. J Thorac Imaging. 2005 Feb;20(1):41-6
Keywords
Tracheobronchial amyloidosis, Airway amyloidosis,

No. of Applicants : 100

▶ Correct Answer : 19/100,  19.0%
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Korea University Guro Hospital , Korea (South) SEIYOUNG LEE
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - Korea University Guro Hospital , Korea (South) PARK SOYEON
  • - the First Affiliated Hospital of NanJing Medical University , China AIPING CHEN
  • - Myongji Hospital , Korea (South) KYUNGHO KIM
  • - speciality medical officer , India DIVYESHKUMAR RAMNIKLAL DADHANIA
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Korea University Guro Hospital , Korea (South) YOUKYOUNG LEE
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Korea University Anam Hospital , Korea (South) DONGKYU LEE
  • - Korea University Guro Hospital , Korea (South) HWANSEOK YONG
  • - Korea University Guro Hospital , Korea (South) Yoonmi Choi
▶ Correct Answer as Differential Diagnosis : 49/100,  49.0%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - , Korea (South) HANKYUL KIM
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - , Korea (South) DONG-HO BANG
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Other , Korea (South) SEONG SU KANG
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - HHS , Canada S LEE
  • - Other , Korea (South) SUNG HYUN YOON
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Chonbuk National University Hospital , Korea (South) WON HYEONG IM
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) MINKYU KWAK
  • - Other , Korea (South) HAYEON LEE
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - GHICL , France MANUEL TOLEDANO
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - University of New South Wales , Australia RASHID HASHMI
  • - Other , Korea (South) DONGHWAN KIM
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - , Japan FUJIMOTO KEITA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Seoul National University Hospital , Korea (South) YONGSUB SONG
  • - The University of Tokyo Hospital , Japan TOMOKI WADA
  • - Private sector , Greece VASILIOS TZILAS
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