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Weekly Chest CasesArchive of Old Cases

Case No : 1203 Date 2020-11-16

  • Courtesy of Jongmin Park, Byunggeon Park, Jae-Kwang Lim / Kyungpook National University Hospital
  • Age/Sex 46 / F
  • Chief Complaintincidentally found abnormality on chest CT
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Amyloidosis
Radiologic Findings
Chest radiograph shows a few small nodules in right upper and both lower lung fields (Figure. 1). Lung and mediastinal setting of contrast-enhanced chest CT images shows multiple thin-walled cysts and several pulmonary nodules that contain nodular calcifications. Some of the calcifications are located within the cystic leisons (Figure. 2-7).

After surgical biopsy, pulmonary amyloidosis was confirmed.
Brief Review
Amyloidosis can be classified on the basis of its anatomic distribution or the structure of the extracellular protein deposits. Amyloidosis can be localized or systemic (and often lethal if not effectively treated). Involvement of the lung is relatively common, but rarely symptomatic. Amyloidosis can appear in the lung in three different forms: nodular pulmonary amyloidosis, diffuse alveolar-septal amyloidosis and tracheobronchial amyloidosis. Lung diseases characterized by chronic inflammation (e.g. bronchiectasis and cystic fibrosis) can give rise to systemic AA (apolipoprotein serum amyloid A) amyloidosis. Moreover, respiratory manifestations are common in systemic amyloidosis. Finally, amyloid deposits can directly target the lung and respiratory tract. Nodular amyloidosis, as in this patient, is almost always localized to the lungs. The nodules usually are concentrated in the lower lobes and are typically subpleural or peripheral. They vary in shape and size (range, 0.5–15.0 cm). Calcification or ossification is seen in up to 50% of cases and can help indicate the diagnosis. In rare instances, nodular amyloid deposits may be associated with cysts
Please refer to
Case 72, Case 277, Case 298, Case 379, Case 478, Case 509, Case 608, Case 664, Case 738, Case 786, Case 794, Case 834, Case 900, Case 927, Case 939, Case 982, Case 985, Case 998, Case 1038, Case 1097,
KSTR imaging conference 2017 Summer  Case 10 ,
KSTR Imaging Conference 2015 Spring  Case 4 ,
KSTR Imaging Conference 2011 Spring  Case 8,
References
1. Milani, P., Basset, M., Russo, F., Foli, A., Palladini, G., & Merlini, G. (2017). The lung in amyloidosis. European Respiratory Review, 26(145).
2. Lee, A. Y., Godwin, J. D., & Pipavath, S. N. (2012). Case 182: pulmonary amyloidosis. Radiology, 263(3), 929-932.
Keywords
lung, amyloidosis,

No. of Applicants : 78

▶ Correct Answer : 42/78,  53.8%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - McGill , Canada ADRIANA SOFIA MORALES
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Turkey MEHMET DURAN
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) MIN A LEE
  • - Other , Korea (South) MINSU KIM
  • - Kyeongpook National University Hospital , Korea (South) MIRAN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Japan HIROAKI ARAKAWA
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Chonbuk National University Hospital , Korea (South) SOL KI KIM
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 6/78,  7.7%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Fortis hospital , Mohali , India SHALEEN RANA
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