Embed Size (px)
Citation preview
BMJ Case Reports 2012; doi:10.1136/bcr.11.2011.5166 1 of 2
DESCRIPTIONA 70-year-old man presented with non-specifi c chest pains. A low-grade tubulovillous adenoma had pre-viously been removed from his colon and he was an ex-smoker. A chest radiograph revealed multiple pul-monary masses. He subsequently underwent a staging CT examination (fi gure 1a,b) which revealed multiple
irregular, predominantly pleurally based masses with foci of calcifi cation, necrosis and cavitation. They mea-sured up to 5.5 cm in diameter. Radiologically they were concerning for malignancy and a CT guided biopsy was performed. The biopsies contained abundant amorphous eosonophilic material which stained with Congo Red, in keeping with amyloid (fi gure 2a,b).
Images in...
Pulmonary amyloidosis – an unusual cause of chest pain
Frances Anne Hampson,1 Doris M Rassl,2 Robert C Rintoul,3 Nagmi R Qureshi1
1Radiology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK;2Histopathology Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK;3Respiratory Medicine Department, Papworth Hospital NHS Foundation Trust, Cambridge, UK
Correspondence to Dr Frances Anne Hampson, [email protected]
Figure 1 (a) High resolution axial CT image demonstrating multiple irregular, predominantly pleurally based masses measuring up to 5.5 cm in diameter. (b) Axial CT image displayed on mediastinal windows setting which demonstrates small foci of necrosis with cavitation (white arrows) and calcifi cation (black arrow) within one of the masses.
Figure 2 (a) H&E section showing abundant amorphous eosinophilic material (light pink areas) in keeping with amyloid. (b) Congo red stain showing apple green birefringence under polarised light.
BMJ Case Reports 2012; doi:10.1136/bcr.11.2011.51662 of 2
Learning points
Amyloidosis can be systemic or localised. ▶ 1–3 Localised amyloidosis in the chest can either affect the lung parenchyma or the airways.1 Parenchymal disease can either take the form of parenchymal nodular amyloidosis (as in this case) or parenchymal alveolar septal amyloidosis.1
Parenchymal nodular amyloidosis is rare ▶ 1 and affected patients are usually asymptomatic.2 The nodules may be single or multiple, most often measuring between 0.5-5 cm in diameter.1 3 They tend to be peripheral and frequently calcify. Typically the nodules are round with smooth contours but they can be oval, lobulated, irregular or spiculated. Necrosis and cavitation as in this case is unusual.1
Amyloid nodules may show increased uptake ▶
on imaging with PET-CT so biopsy is required to confi dently distinguish between amyloid and malignancy.1
Competing interests None.
Patient consent Obtained.
REFERENCES 1. Hansell DM, Lynch DA, Page McAdams H, et al. Imaging diseases of the
chest. Fifth Edition. Chapter 11. Idiopathic Diffuse Lung Diseases. Missouri:
Mosby Elsevier 2010:641–713.
2. Pickford HA, Swensen SJ, Utz JP. Thoracic cross-sectional imaging of
amyloidosis. AJR Am J Roentgenol 1997;168:351–5.
3. Aylwin AC, Gishen P, Copley SJ. Imaging appearance of thoracic amyloidosis.
J Thorac Imaging 2005;20:41–6.
This pdf has been created automatically from the fi nal edited text and images.
Copyright 2012 BMJ Publishing Group. All rights reserved. For permission to reuse any of this content visit http://group.bmj.com/group/rights-licensing/permissions. BMJ Case Report Fellows may re-use this article for personal use and teaching without any further permission.
Please cite this article as follows (you will need to access the article online to obtain the date of publication).
Hampson FA, Rassl DM, Rintoul RC, Qureshi NR. Pulmonary amyloidosis – an unusual cause of chest pain. BMJ Case Reports 2012;10.1136/bcr.11.2011.5166, Published XXX
Become a Fellow of BMJ Case Reports today and you can:Submit as many cases as you like ▶Enjoy fast sympathetic peer review and rapid publication of accepted articles ▶Access all the published articles ▶Re-use any of the published material for personal use and teaching without further permission ▶
For information on Institutional Fellowships contact [email protected]
Visit casereports.bmj.com for more articles like this and to become a Fellow
Keep up to date with all published cases by signing up for an alert (all we need is your email address) http://casereports.bmj.com/cgi/alerts/etoc
