THORACIC CROSS-SECTIONAL IMAGING OF AMYLOIDOSIS

OBJECTIVE. Our objective was to determine the thoracic manifestations on cross-sectional imaging of patients with tissue-proven amyloidosis. MATERIALS AND METHODS. We reviewed the records of 300 patients with t he diagnosis of amyloidosis on whom cross-sectional imaging was done a t our institution between 1985 and 1995. After exclusions, 19 patients with tissue-proven amyloidosis and cervicothoracic cross-sectional im aging were included. Seven patients had localized amyloidosis and 12 p atients had systemic amyloidosis. Eighteen patients underwent CT scans and the remaining patient, MR imaging. RESULTS. Two patients with sys temic amyloidosis had widespread noncalcified adenopathy. A third pati ent had an infiltrative soft-tissue process in the mediastinum and axi llae containing thick linear and focal calcifications. Five patients w ith localized amyloidosis had pulmonary nodules: Three patients had so litary nodules, one patient had two nodules, and one patient had IO no dules. Nodules ranged in size from 8 mm to 3 cm. Eight patients with s ystemic amyloidosis had diffuse lung disease. One patient with systemi c amyloidosis had recurrent right pleural effusions. Two patients with localized amyloidosis had laryngotracheobronchial amyloidosis. One of the two patients had focal thickening of the right aryepiglottic fold . The other patient had diffuse concentric soft-tissue thickening with in the trachea. CONCLUSIONS, Localized amyloidosis can occur in patien ts as pulmonary nodules or as laryngotracheobronchial involvement. Nod ules are typically solitary (60%) with a smooth or lobular contour and are frequently in a subpleural or peripheral location. Calcification is not common (20%). Systemic amyloidosis can occur in patients as a c ombination of adenopathy (75%), multiple pulmonary nodules (50%), and diffuse irregular lines or interlobular septal thickening (50%).