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Weekly Chest CasesArchive of Old Cases

Case No : 1349 Date 2023-08-28

  • Courtesy of Kyu Bin Kim / Pusan National University Yangsan Hospital
  • Age/Sex 62 / F
  • Chief ComplaintMultiple lung nodules
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Diagnosis With Brief Discussion

Diagnosis
Pulmonary amyloidosis (nodular parenchymal type)
Radiologic Findings
Fig 1. Chest PA shows
- Mottled calcifications, linear streaky opacities at RULz, suggesting old pulmonary TB.
- Multinodular opacities at bilateral lung (the largest : at right middle lung zone)
Fig 2-6 CT scan reveals
- Well-defined multiple nodules with lobulated margin at bilateral lung.
- Nodules with or without calcification.
- Calcifications with fibrostreaky opacity at RUL apical segment, suggesting old TB.
Brief Review
Pulmonary amyloidosis
- Rare manifestation of amyloidosis by involvement of lung parenchyma

There are three patterns of pulmonary amyloidosis.
- Diffuse tracheobronchial amyloidosis
- Nodular parenchymal type
- Diffuse alveolar septal type

Nodular parenchymal type
1. Clinical features
- Benign clinical course with indolent growth over time
2. Image findings
A. Solitary pulmonary mass (amyloidoma)
B. Multiple pulmonary nodules
C. Variable size and margins
- from smooth to spiculated margin
D. Progressive calcification over time
References
Sugi et al. Amyloidosis : multisystem spectrum of disease with pathologic correlation
- RadioGraphics 2021; 41:1454–1474
Keywords

No. of Applicants : 84

▶ Correct Answer : 20/84,  23.8%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Chonnam National University Hwasun Hospital , Korea (South) KWANGKUN CHO
  • - , Japan KYOKO NAGAI
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
  • - Osaka University , Japan AKINORI HATA
  • - , Japan HIKARI FUKUI
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - , Japan YUKIKO USUI
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - , Japan MIYUKO FUJITA
  • - Other , Korea (South) SEONG WON JANG
  • - Others , India PURUSHOTHAMA RAO TUMMALA
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - Other , Korea (South) YONG HO JANG
  • - , Korea (South) JIN WOO YOON
▶ Correct Answer as Differential Diagnosis : 22/84,  26.2%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - , Korea (South) KIM HYE IN
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Chonnam Hospital , Korea (South) JAEHYUN PARK
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Chonnam National University Hwasun Hospital , Korea (South) SONG MYUNG WON
  • - , Japan NOBUYUKI OTANI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - Jiangsu province hospital , China WANGJIAN ZHA
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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