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Weekly Chest CasesArchive of Old Cases

Case No : 1097 Date 2018-11-06

  • Courtesy of Sung Ho Hwang, Yu-Whan Oh / Korea University Anam Hospital, Seoul
  • Age/Sex 56 / F
  • Chief ComplaintA 56-year-old female visited our institute to evaluate multiple lung nodules
  • Figure 1
  • Figure 2

Diagnosis With Brief Discussion

Diagnosis
Pulmonary Amyloidosis
Radiologic Findings
Chest radiography shows multiple small nodules in bilateral lung fields (Fig. 1). Contrast-enhanced chest CT images (Fig. 2 A and B) with a mediastinal window set show multiple irregular high-attenuation nodules (size range, 1-2 cm) in bilateral lungs. The lower lobe of left lung has severe bronchial stenosis with small high-attenuation nodule (Fig. 2A). When reviewed the chest CT images (Fig. 2 C and D) taken at 2018 and 2013, the heterogeneous lesion in the lower lobe of right lung has remarkable enlargement of high-attenuation components.
Brief Review
Amyloidosis refers to a group of conditions characterized by extracellular deposition of abnormal protein and protein derivatives. The vast majority of cases of amyloidosis fall into two distinct classes: 1) primary amyloid light chain disease (with immunoglobulin light chains by plasma cell) and 2) secondary amyloid A chain disease . The primary amyloid light chain disease (with chronic inflammatory disorders).
Primary systemic amyloidosis usually results in a reticulonodular pattern due to diffuse interstitial parenchymal involvement on radiograph. This appearance must be differentiated from the finding of increased reticular markings and prominent interlobular septa resulting from congestive failure due to cardiac amyloidosis. On chest CT images, we have noticed that the abnormal areas by amyloidosis can calcify or, rarely, show frank ossification. In addition, the localized form of amyloidosis may manifest as single or, less commonly, multiple lung nodules or masses (nodular parenchymal amyloidosis), or as thickening and calcification of airway walls (tracheobronchial amyloidosis).
References
1. Ayuso MC, Gilabert R, Bombi JA, et al. CT appearance of localized pulmonary amyloidosis. J Comput Assist Tomogr1987;11:197–199.
2. Pickford HA, Swensen SJ, Utz JP. Thoracic cross-sectional imaging of amyloidosis. AJR Am J Roentgenol1997;168:351–355.
Keywords
Lung,

No. of Applicants : 77

▶ Correct Answer : 28/77,  36.4%
  • - 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
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - Other , Korea (South) HEE SEOK CHOI
  • - Other , Korea (South) SEONGSU KANG
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Gifu University Hospital , Japan Yo Kaneko
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Seoul National University Hospital , Korea (South) SE WOO KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - , Korea (South) JANG SEONG WON
  • - Louisiana State University - Shreveport , United States CARLOS H PREVIGLIANO
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - TB centre kasaragod. , India rikhy krishnan
  • - , Japan SHINTARO ICHIKAWA
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Seoul Veterans Hospital , Korea (South) HYUN JUNG YOON
▶ Correct Answer as Differential Diagnosis : 15/77,  19.5%
  • - radiologist, aditya imaging centre , India VIVEK PATEL
  • - , United Kingdom SAMSON K
  • - Chungbuk National University College of Medicine , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - The Jikei university , Japan TAKU GOMI
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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