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Weekly Chest CasesArchive of Old Cases

Case No : 794 Date 2013-01-14

  • Courtesy of Jae Yeon Wi, Chang Min Park / Seoul National University Hospital
  • Age/Sex 50 / F
  • Chief ComplaintBreast cancer work-up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Primary Pulmonary Amyloidosis
Radiologic Findings
The abnormality in tracheobronchial tree was incidentally detected on the Chest CT which was performed to evaluate the breast cancer.
With the suspicion of tracheobronchial amyloidosis, the patient underwent bronchoscopy.
Diffuse mucosal swelling and luminal narrowing was noted and the fixed obstruction of bronchus which did not dilate with inspiration was observed. Mucosal biopsy was done at bilateral proximal bronchus. The pathology revealed chronic inflammation with noneoplastic bronchial tissue and Congo-red staining revealed amyloid of greenish birefringence under polarized light microscopy.
Brief Review
Primary pulmonary amyloidosis is a rare disorder that appears in three forms: tracheobronchial form, nodular parenchymal form, and diffuse parenchymal form. Primary tracheobronchial amyloidosis is generally not associated with parenchymal abnormalities. Amyloid materials deposit in the submucosal area and most commonly involve the entire trachea. Infrequently, a solitary submucosal nodule can be present. On CT, tracheobronchial amyloidosis usually leads to diffuse, concentric, smooth, or nodular thickening of the submucosal tracheal wall. Cartilage is normal but concentric calcification or ossification may occur without tracheomalacia. Bronchoscopy proved to be the most useful diagnostic method in establishing the diagnosis by biopsy. Diagnosis requires histological confirmation through biopsy, in which pathologic specimens stained with Congo-red reveal greenish birefringence under polarized light microscopy.
References
1. Kim H.Y., Im J.G., Song K.S., et al. Localized amyloidosis of the respiratory system: CT features. J Comput Assist Tomogr 1999;23:627-631.
2. O'Regan A., Fenlon H.M., Beamis J.F., Jr, et al. Tracheobronchial amyloidosis. The Boston University experience from 1984 to 1999. Medicine (Baltimore) 2000;79:69-79
Keywords
Airway, Metabolic and storage lung disesae,

No. of Applicants : 103

▶ Correct Answer : 54/103,  52.4%
  • - SNUH , Korea (South) Euijin Hwang
  • - Gyeongsang National Universit Hospital , Korea (South) SungEun Park
  • - Dae-jeon Bohun Veterans Hospital , Korea (South) KI-TAE HAN
  • - the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - SGPGIMS LUCKNOW , India Sriram Patwari
  • - University of British Columbia , Canada Amr Ajlan
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Montreal , Canada Drago Le King
  • - Konkuk University Medical Center , Korea (South) Inyoung Song
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - Seoul National University Hospital , Korea (South) YongSub Song
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - HUEC , Brazil Diogo Pinheiro
  • - Seosan Medical Center , Korea (South) Sang Min Lee
  • - , Korea (South) Sanghyuk Ahn
  • - Pneumology GHSR , Reunion fabrice paganin
  • - Saint Malo , France jean-baptiste Noel
  • - McGill University Health Center , Canada Alexandre Semionov
  • - UWO , Canada S Lee
  • - chp st martin , France Mariotte benoit
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Suncheon Plus Medicine , Korea (South) Park Sang Hyun
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - Samsung medical center , Korea (South) Soyi Kwon
  • - Kyunghee university medical center at Kangdong , Korea (South) Soyoun Shin
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - XiangYa hospital , China Xia Yu
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Asan Medical Center , Korea (South) Eunyoung Kim
  • - Myongji hostipal , Korea (South) Yongsuk Jang
  • - Hanyang Medical Center , Korea (South) Kibo Yoon
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - China Medical University , Ditmanson Medical Foundation Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Teikyo mizonokuchi hospital , Japan Takana Yamakawa
  • - Kyoto University , Japan Akihiko Sakata
  • - Medicheck health care , Korea (South) Chae Lim
  • - Okayama university , Japan Mayu Uka
  • - Gangnam Severance Hospital , Korea (South) Chul Hwan Park
▶ Correct Answer as Differential Diagnosis : 20/103,  19.4%
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Khoo Teck Phuat Hospital Singapore , Singapore ashish chawla
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - Fukuyama city hospital , Japan Ryotaro Kishi
  • - Goa Medical College , India Paresh Desai
  • - GM InHospital , Korea (South) Ju Won Lee
  • - Universite de Sherbrooke , Canada Maxime Noel-Lamy
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - McGill university , Canada Badriya Al-Qassabi
  • - HIA Desgenettes , France Francois Le Moigne
  • - Saga University , Japan Ryoko Egashira
  • - Hopital du Sacre Coeur , Canada Andrea Ojanguren
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - All India Institute of medical sciences , India Justin Moses
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
▶ Semi-Correct Answer : 1/103,  1.0%
  • - GHICL , France manuel toledano
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