Presentation
Progressive dyspnea over the past 2-3 days. No fever. No known history of malignancy.
Patient Data
Patchy airspace opacity is present bilaterally, predominantly in the mid and lower zones. Multiple bilateral nodular pulmonary densities suggests multiple lung masses, which could be due to metastases.
Focal areas bibasal consolidation with multiple scattered pulmonary parenchymal masses of varying size. In addition, a large mass is present in the right lung base. Hyperdense foci are present in the left lower lobe mass suggestive of calcification. Mild background emphysematous changes. Extensive mediastinal and hilar adenopathy.
Overall, the findings suggest primary right basal pulmonary malignancy with widespread metastatic disease. Possible superimposed infection.
Tissue was obtained via trans-bronchial biopsy of the right lower lobe mass.
HISTOLOGY:
- special stains (Congo red and crystal violet) and immunohistochemistry (amyloid P component) for amyloid were undertaken
- extracellular deposits stain positively for amyloid
- no evidence of malignancy, granulomata, or fungal elements
Sputum microscopy and culture:
- positive for Haemophilus influenzae
Case Discussion
A case of nodular pulmonary amyloidosis in a patient treated for an infective exacerbation of COPD due to haemophilus influenzae.
Previous external imaging (unavailable) demonstrated that the nodules were longstanding.
Acknowledgements: Dr Rachael O'Rourke.
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