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Weekly Chest CasesArchive of Old Cases

Case No : 982 Date 2016-08-22

  • Courtesy of So Young Choi, MD / Eulji University Hospital
  • Age/Sex 57 / M
  • Chief ComplaintIncidental abnormalities on chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Amyloidosis
Radiologic Findings
Chest PA shows consolidation in the right lower lung field and right pleural effusion (Fig 1). Chest CT scan mediastinal setting images show consolidation with multifocal calcifications in the right middle and lower lobes, and the right pleural effusion ( Fig.2-5). CT-guided TTNB was performed. The specimen showed perivascular hyalinization with deposition of amorphous eosinophilic material, which showed positivity with Congo red stain. This lesion was confirmed as amyloidosis..
Brief Review
Amyloidosis is a systemic disease caused by extracellular accumulation of amyloid substances. 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). There are three classifications of pulmonary involvement: (1) diffuse or alveolar septal, (2) localized nodular, and (3) tracheobronchial amyloidosis.
Nodular parenchymal amyloidosis is manifested as solitary or, less commonly, multiple nodules usually ranging from 0.5 to 15 cm in diameter. The nodules usually are concentrated in the lower lobes and are typically subpleural or peripheral. Calcification or ossification is seen in up to 50% of cases. Amyloid nodules in the lung parenchyma are usually an incidental finding that need to be distinguished from neoplasia.
Amyloidosis is diagnosed on the basis of apple-green birefringence under a polarized light microscope after staining with Congo red, and the presence of rigid, non-branching fibrils, 7.5–10 nm in diameter, on electron microscopy.
Please refer to Case 277, Case 379, Case 608, Case 786, Case 900, Case 927, Case 939
.
References
1. IG Vieira, et al. Pulmonary amyloidosis with calcified nodules and masses-a six-year computed tomography follow-up: a case report Cases J 2009;2:6540
2. AY Lee, et al. Pulmonary Amyloidosis Radiology 2012;263:929-932
3. Gillmore JD, Hawkins PN. Amyloidosis and the respiratory tract. Thorax 1999;54:444-451

4. Utz JP, Swensen SJ, Gertz MA. Pulmonary amyoidosis. The Mayo Clinic experience from 1980 to 1993. Ann Intern Med 1996;124:407-413

Please refer to
Case 379 Case 834
Keywords
Lung, Metabolic and storage lung disesae,

No. of Applicants : 750

▶ Correct Answer : 25/750,  3.3%
  • - Samsung Medical Center , Korea (South) Boda Nam
  • - Military service , Korea (South) Dong Jang
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Konkuk University Medical Center , Korea (South) Yong Wonn Kwon
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - University of Tsukuba Hospital , Japan Hiroaki Takahashi
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Korea University Guro Hospital , Korea (South) Sun Hong
  • - Korea University Guro Hospital , Korea (South) Hwanseok Yong
  • - Korea University Guro Hospital , Korea (South) Sooyoung Chae
  • - Korea university medical center, guro hospital , Korea (South) JINWOO HAN
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Ajou University Hospital , Korea (South) Youngjin Yoo
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - GHICL , France manuel toledano
  • - The University of Tokyo Hospital , Japan Kaoru Sumida
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - , Korea (South) BAEK YOOLIM
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - Pusan National University Hospital , Korea (South) Park JeongBin
▶ Correct Answer as Differential Diagnosis : 19/750,  2.5%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - , Korea (South)
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - University of Tsukuba, Dept of Radiology , Japan Manabu Minami
  • - sunder lal jain hospital , India sanjeev vachher
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - CNUH , Korea (South) LEE JAE
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
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