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Mihalova TZ, Ivanova SS, Mekov EV, Yamakova YТ, Petkov RE. Ultrasound-controlled transthoracic true-cut needle biopsy in pulmonary nodular amyloidosis. Respirol Case Rep 2023; 11:e01142. [PMID: 37200954 PMCID: PMC10186149 DOI: 10.1002/rcr2.1142] [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: 12/04/2022] [Accepted: 03/30/2023] [Indexed: 05/20/2023] Open
Abstract
The current case report presents a 59-year-old man with imaging studies of the thorax showing nodular lesions in the lungs bilaterally. Based on radiographic and CT images, preliminary diagnoses for possible granulomatosis (tuberculosis) or pulmonary metastatic dissemination of a neoplastic process were made. An ultrasound-controlled transthoracic true-cut needle biopsy of a subpleural lesion was performed. Special staining with Congo red and examination with a polarizing light microscope for detection of amyloid confirmed the diagnosis of 'pulmonary nodular amyloidosis' by visualizing green birefringence.
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Affiliation(s)
- Teodora Z. Mihalova
- Clinic for Treatment of Nonspecific Lung Diseases and TuberculosisUMHAT “St. Ivan Rilski”, Medical University—SofiaSofiaBulgaria
| | - Silviya S. Ivanova
- Department of PathomorphologyUMHAT "St. Ivan Rilski", Medical University—SofiaSofiaBulgaria
| | - Evgeni V. Mekov
- Department of Professional DiseasesUMHAT “St. Ivan Rilski”, Medical University—SofiaSofiaBulgaria
| | - Yordanka Т. Yamakova
- Department of Intensive Care, Clinic for CardiologyUMHAT “Alexandrovska”, Medical University—SofiaSofiaBulgaria
| | - Rosen E. Petkov
- Clinic for Treatment of Nonspecific Lung Diseases and TuberculosisUMHAT “St. Ivan Rilski”, Medical University—SofiaSofiaBulgaria
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Tambuzzi S, Gentile G, Boracchi M, Marasciuolo L, Zoja R. Post-Mortem Diagnosis of a Rare Case of Massive Nodular Pulmonary Amyloidosis in a Forensic Setting. Acad Forensic Pathol 2023; 13:41-47. [PMID: 37091197 PMCID: PMC10119865 DOI: 10.1177/19253621231164023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/24/2023] [Indexed: 04/25/2023]
Affiliation(s)
| | - Guendalina Gentile
- Guendalina Gentile BSc, Sezione di Medicina
Legale—Dipartimento di Scienze Biomediche per la Salute—Università degli Studi, via Luigi
Mangiagalli, 37, 20133 Milano, Italy;
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3
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Patel H, Sheikh A, Medarametla GD, Selvam SA, Mahmood SN, Johal G, Arunachalam J, Radhakrishnan H, Shah V, Vallath AL, Patel D, Palasamudram Shekar S, Patel U, Changawala N. Uncommon Presentation of Undiagnosed B-Cell Lymphoproliferative Disorder as Nodular Pulmonary Amyloidosis. J Med Cases 2023; 14:36-43. [PMID: 36755997 PMCID: PMC9881482 DOI: 10.14740/jmc4026] [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: 11/21/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
B-cell lymphoproliferative disorders are characterized by the accumulation of mature B lymphocytes in the bone marrow, lymphoid tissues, and/or peripheral blood. They can cause amyloid deposits in the lungs. In rare cases, lung nodules can be the first sign of this disorder. We present the case of an 89-year-old woman with stable shortness of breath and lung nodules on imaging. A positron emission tomography-computed tomography (PET-CT) scan showed the most intense hypermetabolic nodule in the patient's lung, which was 1.5 × 1.4 cm. A biopsy of this nodule showed amyloid material with trapped plasma cell infiltrate on microscopy. Congo red stain under polarizing microscopy showed apple-green birefringence, which is diagnostic for amyloidosis. Immunohistochemistry showed a mixture of kappa-positive and lambda-positive cells. B-cell gene rearrangement-clonal gene rearrangements were detected in the immunoglobulin heavy chain (IgH) gene and the kappa light chain (IGK). These findings suggest a B-cell lymphoproliferative disorder, such as a plasmacytoma or a marginal cell lymphoma with plasma cell differentiation. The patient was diagnosed with a B-cell lymphoproliferative disorder and pulmonary amyloidosis. Isolated amyloidosis in the lungs usually has a good prognosis, but it can be a sign of autoimmune diseases or B-cell lymphoproliferative disorders, as in this case. Early diagnosis of B-cell lymphoproliferative disorder can lead to successful treatment and prevents complications.
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Affiliation(s)
- Harsh Patel
- Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA,Corresponding Author: Harsh Patel, Department of Family Medicine, Central Jersey Urgent Care, Green Brook, NJ 08812, USA.
| | - Aaiyat Sheikh
- Era’s Lucknow Medical College, Lucknow, Uttar Pradesh 226003, India
| | | | - Sri Abirami Selvam
- Department of Internal Medicine, St Mary Medical Center, Langhorne, PA 19047, USA
| | - Syed Nazeer Mahmood
- Department of Medicine, Section of Pulmonary/Critical Care, MedStar Washington Hospital Center, Washington, DC 20770, USA
| | - Gurleen Johal
- Department of Medicine, Hackensack Meridian Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Janani Arunachalam
- Department of Biomedical Engineering, University of Houston, Houston, TX 77021, USA
| | | | - Viray Shah
- Department of Hospital Medicine, Medstar Good Samaritan Hospital, Baltimore, MD 21239, USA
| | - Aditya Lal Vallath
- Department of Emergency Medicine, Peerless Hospital and BK Roy Research Center, Kolkata, West Bengal 700094, India
| | | | - Saketh Palasamudram Shekar
- Interventional Pulmonology, Department of Pulmonary and Critical care Medicine, Pulmonary and Sleep Associates of Huntsville, Huntsville Hospital, Huntsville, AL 35801, USA
| | - Urvish Patel
- Department of Public Health and Neurology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Lynch H, Qian F, Wong MD, Thomas RJ, Kapur N. Lung parenchymal calcifications in a child with cystic fibrosis. Respirol Case Rep 2022; 10:e0941. [PMID: 35386578 PMCID: PMC8968259 DOI: 10.1002/rcr2.941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/15/2022] Open
Abstract
We describe a 6‐year‐old girl with homozygous p.Phe508del cystic fibrosis with severe multi‐lobar bronchiectasis and obstructive lung disease who was found to have prominent parenchymal calcifications in the right middle lobe on a computed tomography scan of the chest. Histopathology from the calcified area of lung biopsy showed fibrous tissue with chronic inflammation with CD3+ T‐lymphocytes and macrophages with no granulomas. Dystrophic calcification was seen within this necrotic debris.
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Affiliation(s)
- Heidi Lynch
- Department of Pediatric Respiratory and Sleep Medicine Queensland Children's Hospital South Brisbane Queensland Australia
| | - Frank Qian
- Department of Pediatric Respiratory and Sleep Medicine Queensland Children's Hospital South Brisbane Queensland Australia
| | - Matthew D. Wong
- Department of Pediatric Respiratory and Sleep Medicine Queensland Children's Hospital South Brisbane Queensland Australia
- Child Health Research Centre University of Queensland South Brisbane Queensland Australia
- Children's Health Queensland Clinical Unit, Faculty of Medicine University of Queensland South Brisbane Queensland Australia
| | - Rahul J. Thomas
- Department of Pediatric Respiratory and Sleep Medicine Queensland Children's Hospital South Brisbane Queensland Australia
- Child Health Research Centre University of Queensland South Brisbane Queensland Australia
- Children's Health Queensland Clinical Unit, Faculty of Medicine University of Queensland South Brisbane Queensland Australia
| | - Nitin Kapur
- Department of Pediatric Respiratory and Sleep Medicine Queensland Children's Hospital South Brisbane Queensland Australia
- Child Health Research Centre University of Queensland South Brisbane Queensland Australia
- Children's Health Queensland Clinical Unit, Faculty of Medicine University of Queensland South Brisbane Queensland Australia
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Al-Umairi RS, Al-Lawati F, Al-Busaidi FM. Nodular Pulmonary Amyloidosis Mimicking Metastatic Pulmonary Nodules: A case report and review of the literature. Sultan Qaboos Univ Med J 2018; 18:e393-e396. [PMID: 30607286 DOI: 10.18295/squmj.2018.18.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 02/19/2018] [Accepted: 04/26/2018] [Indexed: 12/13/2022] Open
Abstract
Amyloidosis is a disorder characterised by the extracellular deposition of amyloid, a fibrillary protein, in various organs such as the lungs. Pulmonary nodular amyloidosis can mimic other lung conditions that present with pulmonary nodules, such as metastasis, sarcoidosis and hyalinising granuloma. We report a 60-year-old man who presented to the Royal Hospital, Muscat, Oman, in 2017 with a history of shortness of breath upon exertion, orthopnoea and bilateral lower limb swelling. A chest X-ray showed bilateral nodular opacities. Enhanced chest computed tomography revealed bilateral pulmonary nodules with a predominantly perilymphatic and subpleural distribution, giving the impression of a neoplastic nodule. A histopathological examination of biopsied lung tissue confirmed a diagnosis of nodular pulmonary amyloidosis.
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Akkari R, Khishfe BF. Shortness of breath, what did the CXR show? Intern Emerg Med 2017; 12:899-900. [PMID: 28039613 DOI: 10.1007/s11739-016-1593-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Riad Akkari
- Department of Emergency Medicine, Mt Sinai Hospital, 2701 W 68th St, Chicago, IL, 60629, USA
| | - Basem F Khishfe
- Department of Emergency Medicine, Mt Sinai Hospital, 2701 W 68th St, Chicago, IL, 60629, USA.
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Zanetti G, Hochhegger B, Marchiori E. Calcified multinodular lung lesions: a broad differential diagnosis. THE CLINICAL RESPIRATORY JOURNAL 2017; 11:397-398. [PMID: 26076975 DOI: 10.1111/crj.12338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Gláucia Zanetti
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Hochhegger
- Department of Radiology, Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Morgenthal S, Bayer R, Schneider E, Zachäus M, Röcken C, Dreßler J, Ondruschka B. Nodular pulmonary amyloidosis with spontaneous fatal blood aspiration. Forensic Sci Int 2016; 262:e1-4. [DOI: 10.1016/j.forsciint.2016.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/22/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
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Pfeifer K, Mian A, Adebowale A, Alomari A, Kalra V, Krejci E, Shin MS. Radiographic and Pathologic Manifestations of Uncommon and Rare Pulmonary Lesions. Can Assoc Radiol J 2015; 67:179-89. [PMID: 26690551 DOI: 10.1016/j.carj.2015.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/07/2015] [Accepted: 07/28/2015] [Indexed: 12/21/2022] Open
Abstract
Pulmonary opacities/nodules are common findings on computed tomography examinations, which may represent an underlying infections or malignancy. However, not every pulmonary nodule or opacity represents malignancy or infection. We present a pictorial essay illustrating common as well as obscure noninfectious, nonmalignant pulmonary lesions. Lesions discussed include organizing pneumonia, Langerhans cell histiocytosis, pulmonary amyloidosis, hyalinizing granuloma, tumourlet (benign localized neuroendocrine cell proliferations), atypical alveolar hyperplasia, inflammatory myofibroblastic tumour, papillary alveolar adenoma, plasma cell granuloma, juvenile xanthogranuloma, and sclerosing hemangiomas. We discuss the clinical presentation, prevalence, radiographic clues, pathology, and diagnostic pitfalls of these rare lesions.
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Affiliation(s)
- Kyle Pfeifer
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA.
| | - Ali Mian
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Adeniran Adebowale
- Department of Pathology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Ahmed Alomari
- Department of Pathology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Vivek Kalra
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Elise Krejci
- Department of Pathology, Lawrence and Memorial Hospital, New London, Connecticut, USA
| | - Myung Soo Shin
- Department of Radiology, Yale New Haven Hospital, New Haven, Connecticut, USA
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de Almeida RR, Zanetti G, Pereira E Silva JL, Neto CAA, Gomes ACP, Meirelles GDSP, da Silva TKB, Nobre LF, Hochhegger B, Escuissato DL, Marchiori E. Respiratory Tract Amyloidosis. State-of-the-Art Review with a Focus on Pulmonary Involvement. Lung 2015; 193:875-83. [PMID: 26310967 DOI: 10.1007/s00408-015-9791-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/19/2015] [Indexed: 02/06/2023]
Abstract
Amyloidosis is a constellation of disease entities characterized by abnormal extracellular deposition and accumulation of protein and protein derivatives, which show apple-green birefringence when stained with Congo red and viewed under polarized light. Amyloid can infiltrate virtually all organ systems and can display multiple and diverse imaging findings. Pathologically, respiratory involvement occurs in 50 % of patients with amyloidosis, and its clinical signs and symptoms vary depending on whether the disease is systemic or localized. The four main patterns of respiratory tract involvement are tracheobronchial, nodular parenchymal, diffuse alveolar septal, and lymphatic. Imaging findings of amyloidosis are nonspecific and vary in each pattern; knowledge about the disease impairment type is thus very important, and amyloidosis should be considered in the differential diagnosis of other very common diseases, such as infectious diseases, neoplasms, and vasculitis. This literature review describes the main clinical and imaging manifestations of amyloidosis, focusing on respiratory tract involvement and differential diagnosis.
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Affiliation(s)
- Renata Rocha de Almeida
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, Rio de Janeiro, CEP 25685.120, Brazil
| | - Gláucia Zanetti
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, Rio de Janeiro, CEP 25685.120, Brazil
| | | | | | | | | | | | | | - Bruno Hochhegger
- Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, Rio de Janeiro, CEP 25685.120, Brazil.
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Francisco FAF, Rodrigues RS, Barreto MM, Escuissato DL, Araujo Neto CA, Silva JLPE, Silva CS, Hochhegger B, Souza Jr. AS, Zanetti G, Marchiori E. Can chest high-resolution computed tomography findings diagnose pulmonary alveolar microlithiasis? Radiol Bras 2015; 48:205-10. [PMID: 26379317 PMCID: PMC4567357 DOI: 10.1590/0100-3984.2014.0123] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The present study was aimed at retrospectively reviewing high-resolution computed tomography (HRCT) findings in patients with pulmonary alveolar microlithiasis in order to evaluate the frequency of tomographic findings and their distribution in the lung parenchyma. MATERIALS AND METHODS Thirteen patients (9 females and 4 males; age, 9 to 59 years; mean age, 34.5 years) were included in the present study. The HRCT images were independently evaluated by two observers whose decisions were made by consensus. The inclusion criterion was the presence of abnormalities typical of pulmonary alveolar microlithiasis at HRCT, which precludes lung biopsy. However, in 6 cases lung biopsy was performed. RESULTS Ground-glass opacities and small parenchymal nodules were the predominant tomographic findings, present in 100% of cases, followed by small subpleural nodules (92.3%), subpleural cysts (84.6%), subpleural linear calcifications (69.2%), crazy-paving pattern (69.2%), fissure nodularity (53.8%), calcification along interlobular septa (46.2%) and dense consolidation (46.2%). CONCLUSION As regards distribution of the lesions, there was preferential involvement of the lower third of the lungs. No predominance of distribution in axial and anteroposterior directions was observed.
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Affiliation(s)
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ) and Instituto D’Or de Pesquisa e Educação, Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology,
Universidade Federal do Rio de Janeiro (UFRJ), Physician at the Service of Radiology,
Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro
(UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor of Radiology, Department of
Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Cesar Augusto Araujo Neto
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Jorge Luiz Pereira e Silva
- PhDs, Associate Professors, Department of Medicine and
Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
| | - Claudio S. Silva
- MD, Radiology Department, Facultad de Medicina Clinica
Alemana, Universidad del Desarrollo Santiago, Chile
| | - Bruno Hochhegger
- PhD, Associate Professor of Imaging Diagnosis, Universidade
Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Arthur Soares Souza Jr.
- PhD, Professor, Faculdade de Medicina de São José do Rio
Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Gláucia Zanetti
- PhD, Professor, Program of Post-graduation in Radiology at
Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Professor of Medical
Practice, Faculdade de Medicina de Petrópolis, Petrópolis, RJ, Brazil
| | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal
Fluminense (UFF), Niterói, RJ, Associate Professor, Universidade Federal do Rio de
Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Noordzij W, Glaudemans AWJM, van Rheenen RWJ, Dierckx RA, Slart RHJA, Hazenberg BPC. Additional diagnostic value of SPECT/CT to planar Iodine-123 labeled serum amyloid P component scintigraphy in a patient with pulmonary nodular amyloidosis. Amyloid 2014; 21:131-3. [PMID: 24479618 DOI: 10.3109/13506129.2014.881796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
A 62-year-old man presented with a two-week history of dry cough. A chest computed tomography (CT) showed three nodular masses of soft tissue density without calcification or cavitary formation in the right lung. F-18 fluorodeoxyglucose PET/CT scan revealed high FDG uptake in two out of three pulmonary nodules. Transbronchial lung biopsy specimens consisted of amorphous eosinophilic deposits that were demonstrated to be amyloid because they were positive for Congo Red staining. After oxidation with permanganate solution, the Congo Red staining disappeared, indicating that this amyloid was amyloid A protein-derived type. There was no evidence of any systemic diseases. We diagnosed the patient as having multiple nodular pulmonary AA amyloidosis. The patient was conservatively managed without treatment, and the pulmonary nodules disappeared spontaneously three months later.
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