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Khan NA, Bhandari BS, Jyothula S, Ocazionez D, Buryanek J, Jani PP. Pulmonary manifestations of amyloidosis. Respir Med 2023; 219:107426. [PMID: 37839615 DOI: 10.1016/j.rmed.2023.107426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
Amyloidosis is caused by abnormal protein deposition in various tissues, including the lungs. Pulmonary manifestations of amyloidosis may be categorized by areas of involvement, such as parenchymal, large airway and pleural involvement. We describe four distinct manifestations of amyloidosis involving the lung and review their clinical, radiological and pathological features and summarize the evidence for treatment in each of these presentations. We describe alveolar-septal amyloidosis, cystic amyloid lung disease, endobronchial amyloidosis and pleural amyloidosis.
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Affiliation(s)
- Nauman A Khan
- Department of Pulmonary, Critical Care and Sleep Medicine, McGovern School of Medicine, University of Texas McGovern Medical School, Houston, TX, USA.
| | - Bharat S Bhandari
- Department of Pulmonary, Critical Care and Sleep Medicine, McGovern School of Medicine, University of Texas McGovern Medical School, Houston, TX, USA
| | - Soma Jyothula
- Department of Pulmonary Medicine and Lung Transplant at Methodist Hospital, South Texas Medical Center, San Antonio, TX, USA
| | - Daniel Ocazionez
- Department of Diagnostic and Interventional Imaging, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Jamie Buryanek
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School, Houston, TX, USA, USA
| | - Pushan P Jani
- Department of Pulmonary, Critical Care and Sleep Medicine, McGovern School of Medicine, University of Texas McGovern Medical School, Houston, TX, USA
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2
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Marwah V, Rajput AK, Kumar K, Singh S, Sengupta P. Pulmonary diffuse alveolar-septal amyloidosis in association with multiple myeloma: It is not always tuberculosis. Med J Armed Forces India 2023; 79:732-733. [PMID: 37981938 PMCID: PMC10654367 DOI: 10.1016/j.mjafi.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/16/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Vikas Marwah
- Senior Advisor & Professor, (Pulmonary, Critical Care and Sleep Medicine), Army Institute of Cardiothoracic Sciences (AICTS), Pune, India
| | - A K Rajput
- Consultant (Pulmonary Medicine), Artemis Hospital, Gurgaon, India
| | - Kunal Kumar
- Graded Specialist, (Respiratory Medicine), Military Hospital, Namkum, Ranchi, India
| | - Shalendra Singh
- Associate Professor, Department of Anaesthesiology & Critical Care, Armed Forces Medical College, Pune, India
| | - Prashant Sengupta
- Department of Pathology, Command Hospital (Southern Command), Pune, India
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3
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Sun L, Liu K, Li M, Sun Y, Zhu X, Chang C. Tracheobronchial Amyloidosis Accompanied with Asthma: A Case Report and a Mini-Review. J Asthma Allergy 2023; 16:1187-1193. [PMID: 37920270 PMCID: PMC10619460 DOI: 10.2147/jaa.s433639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
Tracheobronchial amyloidosis is a rare disease characterized by amyloid deposits on the tracheal and bronchial tissue. Patients with tracheobronchial amyloidosis are asymptomatic or exhibit symptoms, such as chronic wheezing, dyspnea, and cough, that are common manifestations of other disorders, including asthma. A bronchoscopic tissue biopsy using Congo red staining is the key standard for diagnosing tracheobronchial amyloidosis. Treatment strategies vary depending on the degree of airway obstruction. If the obstruction is significant and the patient is symptomatic, repeated bronchoscopic treatment, including local resection, laser therapy, stent placement, and radiation therapy, is considered a safer and better option. It is often misdiagnosed as asthma, but cases of tracheobronchial amyloidosis accompanied with asthma have not been reported. We report a case of intermittent wheezing, cough for 33 years, and shortness of breath on exertion for 7 years, which had aggravated in the previous 22 days. A pulmonary examination revealed diffuse wheezing. Pulmonary function testing revealed an obstructive ventilation dysfunction. Computerized tomography (CT) imaging revealed circumferential and irregular thickening of the tracheobronchial wall tissue with calcification and atelectasis of the right middle and lower lobe of the lung. Bronchoscopy revealed diffuse thickening of the mucosa of the trachea and bilateral main bronchi, with multiple nodular protuberances and relatively narrow lumens. The bronchial biopsies revealed massive amyloid deposits under the bronchial mucosa. The deposits exhibited a green birefringence under crossed polarized light after Congo red positive staining. The patient received standard treatment for asthma, and remains in good general condition without wheezing. It is not difficult to distinguish tracheobronchial amyloidosis through chest CT examination for patients with wheezing as long as this disease was considered. It was interesting that we present a rarer case of patient with tracheobronchial amyloidosis accompanied with asthma which both can cause symptoms such as wheezing.
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Affiliation(s)
- Lina Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Kexin Liu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Meijiao Li
- Department of Radiology, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Xiang Zhu
- Department of Pathology, Peking University Third Hospital, Beijing, People’s Republic of China
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, People’s Republic of China
| | - Chun Chang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, People’s Republic of China
- Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, People’s Republic of China
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Fukuda T, Egashira R, Ueno M, Hashisako M, Sumikawa H, Tominaga J, Yamada D, Fukuoka J, Misumi S, Ojiri H, Hatabu H, Johkoh T. Stepwise diagnostic algorithm for high-attenuation pulmonary abnormalities on CT. Insights Imaging 2023; 14:177. [PMID: 37857741 PMCID: PMC10587054 DOI: 10.1186/s13244-023-01501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/12/2023] [Indexed: 10/21/2023] Open
Abstract
High-attenuation pulmonary abnormalities are commonly seen on CT. These findings are increasingly encountered with the growing number of CT examinations and the wide availability of thin-slice images. The abnormalities include benign lesions, such as infectious granulomatous diseases and metabolic diseases, and malignant tumors, such as lung cancers and metastatic tumors. Due to the wide spectrum of diseases, the proper diagnosis of high-attenuation abnormalities can be challenging. The assessment of these abnormal findings requires scrutiny, and the treatment is imperative. Our proposed stepwise diagnostic algorithm consists of five steps. Step 1: Establish the presence or absence of metallic artifacts. Step 2: Identify associated nodular or mass-like soft tissue components. Step 3: Establish the presence of solitary or multiple lesions if identified in Step 2. Step 4: Ascertain the predominant distribution in the upper or lower lungs if not identified in Step 2. Step 5: Identify the morphological pattern, such as linear, consolidation, nodular, or micronodular if not identified in Step 4. These five steps to diagnosing high-attenuation abnormalities subdivide the lesions into nine categories. This stepwise radiologic diagnostic approach could help to narrow the differential diagnosis for various pulmonary high-attenuation abnormalities and to achieve a precise diagnosis.Critical relevance statement Our proposed stepwise diagnostic algorithm for high-attenuation pulmonary abnormalities may help to recognize a variety of those high-attenuation findings, to determine whether the associated diseases require further investigation, and to guide appropriate patient management. Key points • To provide a stepwise diagnostic approach to high-attenuation pulmonary abnormalities.• To familiarize radiologists with the varying cause of high-attenuation pulmonary abnormalities.• To recognize which high-attenuation abnormalities require scrutiny and prompt treatment.
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Affiliation(s)
- Taiki Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan.
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga-City, Saga, 849-8501, Japan
| | - Midori Ueno
- Department of Radiology, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-Ku, Kitakyushu, Fukuoka, 807-8556, Japan
| | - Mikiko Hashisako
- Department of Pathology, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka-City, Fukuoka, 812-8582, Japan
| | - Hiromitsu Sumikawa
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180, Nagasone-Cho, Kita-Ku, Sakai-City, Osaka, 591-8555, Japan
| | - Junya Tominaga
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
| | - Daisuke Yamada
- Department of Radiology, St. Luke's International Hospital, 9-1, Akashicho, Chuo-Ku, Tokyo, 104-8560, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki-City, Nagasaki, 852-8523, Japan
| | - Shigeki Misumi
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiroya Ojiri
- Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8461, Japan
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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Marchiori E, Hochhegger B, Zanetti G. Diffuse thickening of the tracheal wall, with calcifications. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20220223. [PMID: 35894417 PMCID: PMC9496260 DOI: 10.36416/1806-3756/e20220223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS), Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
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Kronen R, Ziehr DR, Kane AE, VanderLaan PA, Kholdani CA, Hallowell RW. Pulmonary amyloidosis as the presenting finding in a patient with multiple myeloma. Respir Med Case Rep 2022; 37:101626. [PMID: 35342704 PMCID: PMC8943293 DOI: 10.1016/j.rmcr.2022.101626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ryan Kronen
- Department of Medicine, University of Washington, Seattle, WA, USA
- Corresponding author. Department of Medicine University of Washington, 1959 NE Pacific Street Seattle, WA, 98195, USA.
| | - David R. Ziehr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ashley E.D. Kane
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paul A. VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cyrus A. Kholdani
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert W. Hallowell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Pulmonary amyloidosis diagnosed via transbronchial lung cryobiopsy without surgical lung biopsy: A case series. Respir Med Case Rep 2022; 38:101688. [PMID: 35769635 PMCID: PMC9234253 DOI: 10.1016/j.rmcr.2022.101688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/23/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022] Open
Abstract
Pulmonary amyloidosis is a rare disease characterized by abnormal extracellular deposition of amyloid fibril in the lung tissue, and the identification of amyloid deposits is essential for its diagnosis. Surgical lung biopsy (SLB) is a standard diagnostic method for pulmonary amyloidosis. However, it has a relatively high post-procedural mortality rate. Recently, transbronchial lung cryobiopsy (TBLC) has been gradually used for diagnosing interstitial lung disease. However, its diagnostic efficacy for pulmonary amyloidosis has not yet been validated. Here, we describe two cases of pulmonary amyloidosis with deposition of amyloid light chain detected via TBLC. Since SLB is a high-risk procedure for the patients due to age and complications, TBLC was performed. Both patients presented with Congo red-positive amyloid deposits. One patient with localized pulmonary amyloidosis had a good clinical course without therapeutic intervention and was followed up. The other with systemic amyloidosis received chemotherapy and presented with a stable clinical course. TBLC can collect a larger pulmonary specimen for pulmonary amyloidosis than forceps biopsy and has fewer complications and a lower mortality rate than SLB. Thus, it can be a diagnostic method for pulmonary amyloidosis.
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Sugi MD, Kawashima A, Salomao MA, Bhalla S, Venkatesh SK, Pickhardt PJ. Amyloidosis: Multisystem Spectrum of Disease with Pathologic Correlation. Radiographics 2021; 41:1454-1474. [PMID: 34357805 DOI: 10.1148/rg.2021210006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Amyloidosis is a group of conditions defined by extracellular deposition of insoluble proteins that can lead to multiorgan dysfunction and failure. The systemic form of the disease is often associated with a plasma cell dyscrasia but may also occur in the setting of chronic inflammation, long-term dialysis, malignancy, or multiple hereditary conditions. Localized forms of the disease most often involve the skin, tracheobronchial tree, and urinary tract and typically require tissue sampling for diagnosis, as they may mimic many conditions including malignancy at imaging alone. Advancements in MRI and nuclear medicine have provided greater specificity for the diagnosis of amyloidosis involving the central nervous system and heart, potentially obviating the need for biopsy of the affected organ in certain circumstances. Specifically, a combination of characteristic findings at noninvasive cardiac MRI and skeletal scintigraphy in patients without an underlying plasma cell dyscrasia is diagnostic for cardiac transthyretin amyloidosis. Histologically, the presence of amyloid is denoted by staining with Congo red and a characteristic apple green birefringence under polarized light microscopy. The imaging features of amyloid vary across each organ system but share some common patterns, such as soft-tissue infiltration and calcification, that may suggest the diagnosis in the appropriate clinical context. The availability of novel therapeutics that target amyloid protein fibrils such as transthyretin highlights the importance of early diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Akira Kawashima
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Marcela A Salomao
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Sanjeev Bhalla
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Perry J Pickhardt
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
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Zimna K, Sobiecka M, Langfort R, Błasińska K, Tomkowski WZ. Pulmonary amyloidosis mimicking interstitial lung disease and malignancy - A case series with a review of a pulmonary patterns. Respir Med Case Rep 2021; 33:101427. [PMID: 34401273 PMCID: PMC8348153 DOI: 10.1016/j.rmcr.2021.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/30/2021] [Accepted: 05/07/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Amyloidosis is an uncommon condition, which results from accumulation of misfolded extracellular insoluble protein in tissues and organs of the body, causing its damage and dysfunction. Histologically, after staining with Congo red, the amyloid deposits show an apple-green birefringence under polarized light microscope. Amyloidosis can affect all organ systems and is classified into hereditary or acquired, localized or systemic. Respiratory involvement occurs in 50% of the patients with amyloidosis and it may take tracheobronchial, nodular parenchymal, diffuse alveolar septal and lymphatic forms. METHODS We report four cases of pulmonary amyloidosis. A female patient with localized form of tracheobronchial and nodular parenchymal pulmonary amyloidosis, which was initially misdiagnosed as sarcoidosis. A male patient who was referred to our department for further evaluation of multiple tumors in lungs accompanied by mediastinal lymphadenopathy, liver and peritoneal tumors. A male patient with suspect of lung malignancy. A male patient with diagnosed idiopathic pulmonary fibrosis and the possibility of malignancy. RESULTS All the diagnoses were established by demonstration of amyloid protein in tissue specimens obtained in transbronchial or open lung biopsies. CONCLUSIONS Due to its nonspecific clinical and radiological findings, amyloidosis can often mimic other diseases and should be considered as one of the differential diagnoses. In order to confirm the diagnosis, proving the presence of amyloid deposition with positive Congo red staining in respiratory specimen is mandatory.
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Affiliation(s)
- Katarzyna Zimna
- Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Małgorzata Sobiecka
- Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Renata Langfort
- Department of Pathology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Katarzyna Błasińska
- Department of Radiology, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Witold Z. Tomkowski
- Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Systemic AL amyloidosis presenting with diffuse alveolar septal involvement and respiratory failure: a case report and review of the literature. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Amyloidosis is the extracellular deposition of amyloid fibril protein in any tissue or organ. The clinical manifestations of pulmonary amyloidosis are variable and without specific symptoms. We report a rare case of diffuse alveolar septal amyloidosis which is an extremely rare pattern of involvement, with a very poor prognosis, to improve our understanding of the disease.
Case presentation
A 27-year-old man complained of shortness of breath and cyanosis. High-resolution computed tomography revealed diffuse ground-glass opacifications with interlobular septal thickening in both lungs. The immune-histochemistry showed monoclonal lambda light chains. This case also showed nephrotic syndrome and cardiac arrhythmia, suggesting an involvement of the kidney and the heart. Diagnosis: The diagnosis was finally established by tru-cut transthoracic sonar guided lung biopsy (TSLB), and histological examination revealed Congo red-positive amorphous eosinophilic deposits in the alveolar sept. Interventions: The patient was admitted to a respiratory intensive care unit and put on non-invasive ventilation, then discharged on domiciliary oxygen therapy, and started treatment with chemotherapy melphalan 2 mg daily plus prednisone 60 mg daily immediately after the result of histopathology. Outcomes: Three months after treatment, dyspnea and hypoxemia improved, and he continued treatment. The patient was in a good clinical condition after 10 months of follow-up, but he died suddenly.
Conclusion
As it is difficult to distinguish diffuse alveolar septal amyloidosis from other interstitial and granulomatous lung diseases because of their similar symptoms and imaging findings, thus, transthoracic sonar guided lung biopsy and histological examination is very important in the diagnosis of diffuse alveolar septal amyloidosis.
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11
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Mira C, Montalvão P, Fonseca I, Borges A. Localised laryngotracheal amyloidosis: a differential diagnosis not to forget. BMJ Case Rep 2021; 14:e237954. [PMID: 33526525 PMCID: PMC7853032 DOI: 10.1136/bcr-2020-237954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 02/03/2023] Open
Abstract
We present a case of multifocal laryngotracheal amyloidosis (LTA) in a 43-year-old man with persistent and progressive dysphonia and dyspnoea, and a first inconclusive histology. Although laryngeal amyloidosis accounts for fewer than 1% of all benign laryngeal tumours, it is in fact the most common site of amyloid deposition in the head, neck and respiratory tract. The clinical scenario is non-specific and diagnosis depends on a high degree of suspicion and on histology. Imaging is useful in mapping lesions, which are often more extensive than they appear during laryngoscopy. Despite being a benign entity, the prognosis is variable with a high-rate and long-latency recurrences, requiring long-term follow-up.
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Affiliation(s)
- Catarina Mira
- Radiology Department, Hospital Beatriz Angelo, Loures, Portugal
| | - Pedro Montalvão
- Otorhinolaryngology Deparment, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisbon, Portugal
| | - Isabel Fonseca
- Pathology, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
| | - Alexandra Borges
- Radiology Department, Portuguese Institute of Oncology of Lisbon, Francisco Gentil, Lisboa, Portugal
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Yamada M, Takayanagi N, Yamakawa H, Ishiguro T, Baba T, Shimizu Y, Okudela K, Takemura T, Ogura T. Amyloidosis of the respiratory system: 16 patients with amyloidosis initially diagnosed ante mortem by pulmonologists. ERJ Open Res 2020; 6:00313-2019. [PMID: 32743010 PMCID: PMC7383056 DOI: 10.1183/23120541.00313-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/08/2020] [Indexed: 01/07/2023] Open
Abstract
Background Ante mortem diagnosis of amyloidosis of the respiratory system is rare. Few data are available regarding clinical presentation, precursor proteins, diagnostic procedures, comorbidities, complications, and outcome. We assessed clinical features of a series of patients with amyloidosis of the respiratory system in two Japanese centres. Methods Medical records of 16 patients with amyloidosis of the respiratory system were retrospectively analysed. Amyloid was diagnosed by polarisation microscopy using Congo red-stained tissue specimens and classified immunohistochemically. Results Median patient age was 71 years, and median follow-up period was 5 years. Immunoglobulin light-chain (AL)-λ amyloidosis was found in eight and AL-κ in five patients. Two patients harboured wild-type transthyretin and one harboured serum amyloid A-derived amyloid. Five different forms of amyloidosis of the respiratory system were observed: nodular pulmonary amyloidosis (seven patients), diffuse alveolar-septal amyloidosis (five), mediastinal lymph node amyloidosis (three), tracheobronchial amyloidosis (one), and pleural amyloidosis (one). One patient had diffuse alveolar-septal amyloidosis and mediastinal lymph node amyloidosis. Three of five patients with diffuse alveolar-septal amyloidosis were diagnosed by transbronchial lung biopsy as having concurrent diffuse alveolar haemorrhage or pneumocystis pneumonia. Two of three patients with mediastinal lymph node amyloidosis were diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Conclusions Not only nodular pulmonary amyloidosis, diffuse alveolar-septal amyloidosis, and tracheobronchial amyloidosis but also mediastinal lymph node amyloidosis and pleural amyloidosis should be considered in the differential diagnosis of amyloidosis of the respiratory system. Useful diagnostic methods include transbronchial lung biopsy for diffuse alveolar-septal amyloidosis and endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lymph node amyloidosis. Not only nodular, diffuse alveolar-septal and tracheobronchial amyloidosis but also mediastinal lymph node and pleural amyloidosis should be considered in the differential diagnosis of amyloidosis of the respiratory systemhttps://bit.ly/2ZfZcxo
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Affiliation(s)
- Masami Yamada
- Dept of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Noboru Takayanagi
- Dept of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Hideaki Yamakawa
- Dept of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.,Dept of Respiratory Medicine, Saitama Red Cross Hospital, Saitama, Japan
| | - Takashi Ishiguro
- Dept of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Tomohisa Baba
- Dept of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yoshihiko Shimizu
- Dept of Diagnostic Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Koji Okudela
- Dept of Pathobiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tamiko Takemura
- Dept of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Takashi Ogura
- Dept of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
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13
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Abstract
RATIONALE Pulmonary amyloidosis is a rare respiratory disease characterized by amyloid deposition in the lungs. The clinical manifestations of pulmonary amyloidosis are variable and without specific symptoms. PATIENT CONCERNS We report a rare case of tracheobronchial amyloidosis to improve our understanding of the disease. DIAGNOSES The diagnosis of tracheobronchial amyloidosis was finally established by transbronchoscopic lung biopsy and histological examination. INTERVENTIONS The patient significantly improved with methylprednisolone sodium succinate for injection (40 mg/day) for 5 days and low-dose oral prednisone for 10 days. OUTCOMES After treatment, discomfort, such as cough, stridor, dyspnea, and chest tightness, disappeared, and he was discharged. The patient was in good clinical condition after 8 months of follow-up. CONCLUSION This case clearly shows that it is difficult to distinguish tracheobronchial amyloidosis from other diseases with manifestations of cough, dyspnea and chest tightness because of their similar symptoms and imaging findings. Thus, the role of transbronchoscopic lung biopsy and histological examination in the diagnosis of tracheobronchial amyloidosis is very important.
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Affiliation(s)
- Xiong Peng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University
| | - Xiaolei Wang
- Second Department of Cardiovascular Medicine, Jiangxi Provincial People's Hospital Affiliated of Nanchang University
| | - Daya Luo
- Department of Biochemistry and Molecular Biology, The Basic Medical School of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Zuo
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University
| | - Huiming Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University
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14
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Xian JZ, Cherian SV, Idowu M, Chen L, Estrada-Y-Martin RM. A 45-Year-Old Woman With Multiple Pulmonary Nodules and Sjögren Syndrome. Chest 2019; 155:e51-e54. [PMID: 30732703 DOI: 10.1016/j.chest.2018.08.1077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 02/06/2023] Open
Abstract
CASE PRESENTATION A 45-year-old woman presented for evaluation for 3 months of coughing and dyspnea. A recent chest CT scan done for workup of her symptoms revealed a 2-cm right-sided pulmonary nodule. She had a medical history of Sjögren syndrome, hypertension, and obesity. She also noted a weight loss of 30 lb over the last 3 years. She denied smoking, alcohol consumption, illicit drug use, or occupational exposures. A chest radiograph done 3 years prior did not reveal any pulmonary nodules. She had no personal or family history of arteriovenous malformations, hamartomas, or any malignancies and had been up to date with her breast cancer screening. She was treated with courses of hydroxychloroquine and mycophenolate mofetil for her Sjögren syndrome and did not have a history of opportunistic pulmonary infections. She denied any recent travel or exposure to TB.
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Affiliation(s)
- Jonathan Z Xian
- Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX.
| | - Sujith V Cherian
- Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX
| | - Modupe Idowu
- Division of Hematology, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX
| | - Lei Chen
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX
| | - Rosa M Estrada-Y-Martin
- Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX
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15
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Glass LN, Sumon M, Goulart H, Ahari J. Disappearing nodules: spontaneously regressing pulmonary amyloidosis. BMJ Case Rep 2019; 12:12/5/e229718. [PMID: 31110070 DOI: 10.1136/bcr-2019-229718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A case report of spontaneous regression of pulmonary amyloidosis, diffuse interstitial pattern, in an elderly patient.
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Affiliation(s)
- Lisa N Glass
- Division of Pulmonary, Critical Care and Sleep Disorders Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mahbubur Sumon
- Internal Medicine, Howard University College of Medicine, Washington, DC, USA
| | - Hannah Goulart
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Jalil Ahari
- Pulmonary and Critical Care, The George Washington University, Washington, DC, USA
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16
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Baumgart JV, Stuhlmann-Laeisz C, Hegenbart U, Nattenmüller J, Schönland S, Krüger S, Behrens HM, Röcken C. Local vs. systemic pulmonary amyloidosis—impact on diagnostics and clinical management. Virchows Arch 2018; 473:627-637. [DOI: 10.1007/s00428-018-2442-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 12/11/2022]
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17
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Liu Y, Jin Z, Zhang H, Zhang Y, Shi M, Meng F, Sun Q, Cai H. Diffuse parenchymal pulmonary amyloidosis associated with multiple myeloma: a case report and systematic review of the literature. BMC Cancer 2018; 18:802. [PMID: 30089469 PMCID: PMC6083508 DOI: 10.1186/s12885-018-4565-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/30/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pulmonary is an uncommon site of extramedullary involvement in multiple myeloma (MM). Diffuse parenchymal amyloidosis as pulmonary manifestation of MM is even rarer. We report a rare case of diffuse parenchymal pulmonary amyloidosis associated with MM diagnosed by video-assisted thoracoscopic lung biopsy (VATLB). CASE PRESENTATION A 58-year-old woman complained of cough and shortness of breath. HRCT disclosed diffuse ground-glass opacifications with interlobular septal thickening in bilateral lungs. A lung-biopsy sample obtained by VATLB revealed Congo Red-positive amorphous eosinophilic deposits in the alveolar septa. Surgical biopsy of abdominal wall skin and subcutaneous fat was also performed, which showed the apple-green birefringence with polarized light on Congo red stain was demonstrated in dermis. The serum immunoelectrophoresis showed monoclonal lambda light chains. A bone marrow biopsy specimen comprised 11.5% plasma cells. She was therefore diagnosed with diffuse parenchymal pulmonary amyloidosis accompanied by MM. The patient was referred to the hematology department for further chemotherapy. CONCLUSIONS It is important to recognize diffuse parenchymal pulmonary amyloidosis to avoid misdiagnosis.
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Affiliation(s)
- Yin Liu
- Department of Respiratory, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Zhibin Jin
- Department of Ultrasound, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Haiyan Zhang
- Department of Respiratory, Huainan Chaoyang Hospital, 15 Renmin South Road, Huainan, 232000, Anhui, China
| | - Yingwei Zhang
- Department of Respiratory, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Minke Shi
- Department of Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Fanqing Meng
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Qi Sun
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Hourong Cai
- Department of Respiratory, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
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18
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Amyloidosis as a Cause of Cystic Pulmonary Fibrosis Associated With Pulmonary Nodules. Arch Bronconeumol 2018; 54:481-482. [PMID: 29656944 DOI: 10.1016/j.arbres.2018.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022]
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19
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Zanelli M, Mengoli MC, Puma F, Spaggiari L, Lococo F, De Marco L, Ascani S. Diffuse Alveolar-Septal Amyloidosis Associated With Multiple Myeloma. Int J Surg Pathol 2017; 26:334-335. [PMID: 29183204 DOI: 10.1177/1066896917742200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Magda Zanelli
- 1 Arcispedale Santa Maria Nuova-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Lucia Spaggiari
- 1 Arcispedale Santa Maria Nuova-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Filippo Lococo
- 1 Arcispedale Santa Maria Nuova-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Loredana De Marco
- 1 Arcispedale Santa Maria Nuova-IRCCS Reggio Emilia, Reggio Emilia, Italy
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20
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Kunal S, Dhawan S, Kumar A, Shah A. Middle lobe syndrome: an intriguing presentation of tracheobronchial amyloidosis. BMJ Case Rep 2017; 2017:bcr-2017-219480. [PMID: 28536221 DOI: 10.1136/bcr-2017-219480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary involvement in amyloidosis is a distinct rarity. This clinical entity usually presents as tracheobronchial amyloidosis (TBA). A 32-year-old, never-smoker man presented with episodic dyspnoea and wheezing along with cough and mucoid sputum. The chest radiograph was suggestive of a middle lobe syndrome (MLS). High-resolution CT (HRCT) of the chest confirmed the presence of MLS. In addition, HRCT showed circumferential thickening of the trachea and the main bronchi, with thickening of the posterior membranous wall of trachea. Fibrebronchoscopy, done to evaluate MLS, visualised multiple small polypoidal lesions in the lower part of trachea and carina. Endobronchial biopsies showed homogeneous, acellular amorphous deposit in the subepithelial region, which was congophilic in nature. A diagnosis of TBA presenting as MLS was made. To the best of our knowledge, this is the first detailed report of MLS as a presentation of TBA in the English literature.
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Affiliation(s)
- Shekhar Kunal
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Shashi Dhawan
- Department of Pathology, Histopathology Unit, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Ashok Shah
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
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21
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Revelo AE, Magaspi C, Maguire G, Aronow WS. Hereditary Amyloidosis with Recurrent Lung Infiltrates. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:874-879. [PMID: 27872470 PMCID: PMC5120645 DOI: 10.12659/ajcr.900682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Amyloidosis is a protein conformational disorder characterized by extracellular deposition of amyloid fibrils in extracellular tissue. Lung involvement is most commonly caused by secondary AL amyloidosis. The familial autosomal-dominant senile transthyretin (ATTR) disease manifests mainly as polyneuropathy and restrictive cardiomyopathy denoting the name familial amyloidotic polyneuropathy (FAP). Rarely, this form manifests with clinical and radiologically relevant respiratory tract symptoms and lung involvement. CASE REPORT A 51-year-old male former smoker presented with progressive lower-extremity weakness of several months' duration. He was ultimately diagnosed with chronic demyelinating polyneuropathy and treated with intravenous immunoglobulin therapy. Subsequently, he was admitted with heart failure symptoms and pulmonary infiltrates and his echocardiogram showed a 'myocardial speckled pattern', prompting an endomyocardial biopsy, which showed transthyretin amyloid deposition. He was started on diflunisal. Additionally, serial radiographic imaging of his chest over 3 different admissions for cough, dyspnea, hypoxemia, and lethargy demonstrated recurrent pulmonary infiltrates. A fiberoptic bronchoscopy with trans-bronchial biopsies revealed amyloid deposition in the lung tissue. CONCLUSIONS The clinical presentation of recurrent or persistent pulmonary symptoms and fleeting infiltrates on imaging in a patient with familial amyloidotic polyneuropathy is not common; when present, it should raise the suspicion of respiratory tract involvement.
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Affiliation(s)
- Alberto E Revelo
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, estchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Crischelle Magaspi
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - George Maguire
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Department of Medicine, Divisions of Pulmonary and Critical Care Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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22
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Mihalek AD, Haney C, Merino M, Roy-Chowdhuri S, Moss J, Olivier KN. Exercise-induced haemoptysis as a rare presentation of a rare lung disease. Thorax 2016; 71:865-8. [PMID: 27272655 DOI: 10.1136/thoraxjnl-2015-208020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 05/02/2016] [Indexed: 11/03/2022]
Abstract
Amyloid primarily affecting the lungs is a seldom seen clinical entity. This case discusses the work-up of a patient presenting with exercise-induced haemoptysis and diffuse cystic lung disease on radiographic imaging. The common clinical and radiographic findings of diffuse cystic lung diseases as well as a brief overview of pulmonary amyloid are presented.
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Affiliation(s)
- Andrew D Mihalek
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA Lovelace Respiratory Research Institute, Albuquerque, New Mexico, USA
| | - Carissa Haney
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Maria Merino
- Department of Pathology, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland, USA Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joel Moss
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Kenneth N Olivier
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, Maryland, USA
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