General

Case

Jos#{233} M. Mata,

MD

XavierAlegret,

Figures later

of the

#{149} Jos#{233}C#{225}ceres,

Day1

MD

#{149} Jean

Paul

Senac,

MD

#{149} Jacques

Giron,

MD

MD

1, 2. reveals

(1) Chest that

the

U HISTORY An asymptomatic

radiograph

mass

has

shows

markedly

64-year-old

man

a well-defined

increased

mass

in size

(arrow).

that

(2) Radiograph

a nodule

has

obtained

developed

4 years

(arrow).

pleural effusion was present in the right lung. In addition, a nodule appeared in the left upper lobe and the degree of opacification of the left hilum increased. CT scans showed flocculant calcification within the mass in the right upper lung (Fig 3a), as well as the sub-

underwent

chest radiography and computed tomography (CT) of the thorax as a follow-up of a pulmonary abnormality discovered on a chest radiograph obtained 4 years earlier (Figs 1-3). Results from laboratory studies were noncontributory. U FINDINGS The chest radiograph showed a well-defined right lung. Four years had markedly increased

and

pleural nodule in the left lung and a posterior calcified mass (Fig 3b). A pleural effusion was also seen in the right lung. Enlarged lymph nodes were seen in the mediastinum, some of them calcified (Fig 3c). Analysis of the percutaneous needle biopsy specimen of the mass revealed amyloid. An open biopsy enabled confirmation of the diagnosis. Results of bi-

obtained in 1985 (Fig 1) mass in the apex of the later (Fig 2) the mass in size, and a small

opsy

of the

rectum

and

subcutaneous

fat

were

negative.

Index

terms:

Amyloidosis,

RadloGraphics I

From

San taire

de

C RSNA,

U

28,

Maria

of Diagnostic Claret

Montpellier. 1991.

167,

08025

Montpellier, Address

CT. 60.1211

11:716-718

the Department

Antonio

ruary

716

1991;

#{149} Lung,

60.68

Radiology,

Hospital

Barcelona,

Spain

0MM.,

J.G.).

From

France

reprint

requests

UPS.,

de Ia Santa J.C., the

1990

Creu X.A.)

I Sant and

RSNA

Pau

the scientific

and

the

Department assembly.

Universidad of Diagnostic Received

Aut#{243}noma de Barcelona, Radiology, December

Hospital 18,

1990;

Avenida Universiaccepted

Feb-

toJ.M.M.

1991

RadioGraphics

U

Mata

et a!

Volume

11

Number

4

... -.

h:

ipt

;-:

b. Figure

tion

3. within

(a) CT scan shows flocculant calcificathe mass. (b) CT scan obtained at a

lower level reveals a subpleural nodule (arrow) and a posterior calcified mass (arrowheads). (c) CT scan taken at a lower level than b shows calcified lymph nodes (arrows).

that

area

temic

or may

be a manifestation

amyloidosis.

teristic

forms:

diffuse

parenchymal

It occurs

of sys-

in three

tracheobronchial,

charac-

nodular,

and

!.

chial

form

(3,4).

is probably

The

the

tracheobron-

most

common.

appears as multiple nodules protruding the wall of the trachea. Occasionally, cause narrowing of a segment of the (3).

C.

In the

DIAGNOSIS: lung.

Nodular

amyloidosis

of the

sometimes

chest malities

U DISCUSSION Amyloidosis is a disease characterized extracellular deposit of proteinaceous, twisted, cal

familial,

lung. The volved in the

1991

3-pleated

diversity

main

July

diffuse

parenchymal

volvement is interstitial spread throughout both

sheet

(1,2).

groups: and

primary, senile.

respiratory in patients respiratory

It may

fibrils be

of great classified

secondary, All ofthem

may

be

by an chemiinto

five

confined

organs.

be

regional.

does

form,

the

in-

and is usually widelungs, although not

In many

show

cases,

any

abnor-

(3).

nodular

form

It generally

seldom occurs

involves

other

in patients

over

60

years of age and rarely causes symptoms until the involvement becomes extensive. Amyloid nodules may be solitary or, more commonly, multiple

localized, may affect

system is frequently with amyloidosis. tract

The

it may

radiography

It

from it may trachea

(4) and

are

usually

located

peripher-

the

inDisease to

Mata

et a!

U

RadioGrapbics

U

717

and subpleurally (5). The nodules are not uniform in size or shape. They are often sharply defined, and in about half of the cases, some of them are calcified or ossified. ally

The calcification

may be central

lomatous niosis.

benign

metastasis, diseases, The

vasculitis,

well-defined

borders

by means of percutaneous pulmonary biopsy.

opsy or open sis

is good,

disease.

tumors, granuand pneumocoof the nod-

ules, their different sizes, the presence of calcification in their interior, the presence of calcified mediastinal adenopathy, and their slow growth over years suggest the diagnosis ofamyloidosis. The diagnosis may be con-

U 1.

2.

3.

Glenner

U

Mata

die

of the

treatment

(2).

Ct a!

GG.

Amyloid

deposits and amyloidoN Engl J Med 1980;

Scott

Amyloido-

5i5:

PP, Scott WW, Siegelman 55. an overview. Semin Roentgenol 103-1 12.

1986;

Gross

HB,

dyscrasias. 127.

Felson B, Birngeng in amyloidosis and Semin

Roentgenol

FA. The the plasma 1986;

21:

respiracell

2 1:113-

4.

Rubinow A, Bartolome CR, Cohen AS, Rigden BG, BrodyJS. Localized amyloidosis of the lower respiratory tract. Am Rev Respir Dis

5.

Savaden SJ, Nokes SR, Chappel G. Computed tomography of multiple nodular pulmonary amyloidosis. Comput Radiol 1987; 11:111115. Gross BH. Radiographic manifestations of lymph node involvement in amyloidosis. Radiology 1981; 138:11-14. Wilson SR, Sanders DE, Delanve NC. Intrathoracic manifestations ofamyloid disease. Radiol-

1978;

ogy

RadioGraphics

seldom

REFERENCES

tory tract

7.

U

patients

is no effective

sis. II. The 3-fibnil1oses. 302:1333-1343.

6.

718

and

There

needle biThe progno-

or cloudlike

(3). Uncommonly, cavitation is present. The nodules usually grow slowly, over a period of years rather than months (3). Mediastinal and hilar lymphadenopathy may be present. Lymph node calcification is uncommon; when it occurs, it may be diffuse or of the eggshell type (6). Pleural effusion is present in some patients (7). The differential diagnosis should include

pulmonary

firmed

118:603-611.

1976;

120:283-289.

Volume

11

Number

4