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Weekly Chest CasesArchive of Old Cases

Case No : 1221 Date 2021-03-16

  • Courtesy of Suji Lee / Severance Hospital, Yonsei University College of Medicine
  • Age/Sex 59 / F
  • Chief ComplaintAnal cancer, SLE, Lupus nephritis
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Amyloidosis
Radiologic Findings
Fig 1. Chest PA shows multiple nodules in both lungs.
Fig 2-5. CT scan reveals multiple and variable size lung nodules with calcification and variable size cystic lesions in both lungs.
Brief Review
Amyloidosis is a group of diseases resulting from the extracellular accumulation of abnormal protein in tissues and organs throughout the body. It exists as a primary disease or, more commonly, may be secondary to a wide variety of pathologic processes ranging from chronic infection or inflammation to malignancy. Patients with SLE are rarely associated with pulmonary amyloidosis (usually AA type).
Pulmonary amyloidosis is more often a localized process instead of a part of systemic disease. Two patterns of involvement exist: the nodular parenchymal and the alveolar septal forms. Radiologic findings in both subtypes are often nonspecific.
On chest CT, nodular parenchymal amyloidosis may manifest as solitary or multiple pulmonary nodules and may mimic a variety of diseases from granulomatous disease to malignancy. Multiple pulmonary nodules are common and may exhibit smooth, lobulated, or speculated margins and occasional central or punctate calcification. Rarely, lesions may cavitate. The natural history of nodular parenchymal amyloidosis is benign. Lesions may slowly grow in size and number, but the overall prognosis is excellent and treatment is rarely required.
Alveolar septal pulmonary amyloidosis is characterized by well-defined 2-4mm micronodules accompanied by reticular opacities, interlobar septal thickening, and confluent consolidations with basal and peripheral predominance. Punctate lung calcifications, pleural effusions, and pleural thickening also may occur. Lung cysts have rarely been described, often in patients with systemic amyloidosis due to Sjogren syndrome. The cysts may be associated with calcified or noncalcified soft-tissue nodules. Whether the cysts are a manifestation of lymphocytic interstitial pneumonia in the setting of Sjogren syndrome or a manifestation of amyloidosis is unclear. Compared with nodular pulmonary amyloidosis, patients with diffuse alveolar septal amyloidosis have a far worse prognosis with a median survival of 16 months.
Please refer to
Case 1203, Case 1097, Case 1038, Case 998, Case 985, Case 982, Case 939, Case 927, Case 900, Case 834, Case 794, Case 786, Case 738, Case 664,
KSTR imaging conference 2017 Summer  Case 10 ,
KSTR Imaging Conference 2015 Spring  Case 4 ,
KSTR Imaging Conference 2011 Spring  Case 8,
References
1. Czeyda-Pommersheim F, Hwang M, Chen SS, Strollo D, Fuhrman C, Bhalla S. Amyloidosis: modern cross-sectional imaging. Radiographics 2015;35(5):1381-1392.
2. Ellender CM, McLean C, Williams TJ, Snell GI, Whitford HM. Autoimmune disease leading to pulmonary AL amyloidosis and pulmonary hypertension. Respirology Case Reports 2015;3(2):78-81.
Keywords

No. of Applicants : 115

▶ Correct Answer : 92/115,  80.0%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Korea University Guro Hospital , Korea (South) LEE SEOKYOUNG
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Ajou University Hospital , Korea (South) SUNG HYUN AN
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Other , Korea (South) HYEJIN YANG
  • - Ajou University School of Medicine , Korea (South) JUNG YONG JUN
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Seoul Medical Center , Korea (South) WOONYOUNG BAEK
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Korea (South) SUYON CHANG
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Samsung Medical Center , Korea (South) CHOHEE KIM
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - , Chile DANIEL OCTAVIO CAMPOS
  • - Asan Medical Center , Korea (South) WOOIL KIM
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Inje University Pusan Paik Hospital , Korea (South) DA SOM KIM
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Qatif Central Hospital , Saudi Arabia HANI MAKKY ALSALAM
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - Ajou University Hospital , Korea (South) SEUNGJIN HAN
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Seoul National University Bundang Hospital , 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
  • - , Japan KANAE TAKAHASHI
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - Kyoto University , Japan HIROSHI TAGAWA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - , Korea (South) EUNJIN LEE
  • - Ajou University Hospital , Korea (South) DAYOUNG KIM
  • - Kangwon National University Hospital , Korea (South) SEONGJAE BAE
  • - Korea University Ansan Hospital , Korea (South) MOIN HA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) SEONGHWAN BYUN
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Chungbuk National University Hospital , Korea (South) CHANSEOP KIM
  • - Seoul Medical Center , Korea (South) JUNE PARK
  • - , Japan HIROAKI ARAKAWA
  • - Chonbuk National University Hospital , Korea (South) PARK JUN HYEON
  • - , Saudi Arabia RAWAN AHMED ALJEFRI
  • - TB centre kasaragod. , India rikhy krishnan
  • - , Korea (South) HAJUNG KIM
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Seoul National University Bundang Hospital , Korea (South) HWAYOUNG SONG
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - , Japan TOMOKI IMOKAWA
  • - Tokyo Metropolitan Bokutoh Hospital , Japan TOMOKI WADA
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - , Korea (South) WONJU HONG
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Samsung Medical Center , Korea (South) YOON KYUNG KIM
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 8/115,  7.0%
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - , India PURUSHOTHAMA RAO TUMMALA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
▶ Semi-Correct Answer : 2/115,  1.7%
  • - , France LE GUEN RAPHAEL
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
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