PMC9381353_01
Chest radiograph (A) and chest computed tomography (B) of the patient.
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Chest radiography revealed cardiomegaly and an infiltration shadow in the right lung field (Fig. 1A). Chest computed tomography (CT) revealed multiple infiltrative and ground-glass opacities in the lungs bilaterally (Fig. 1B).
Electrocardiogram (A) and cardiac ultrasound (B, C) of the patient. LVDd 52 mm, LVDs 41 mm, IVSth 16 mm, PWth 14 mm, E/e' 22.2, EF 42%. LVDd: left ventricular diastolic dimension, LVDs: left ventricular systolic dimension, IVSth: interventricular septum thickness, PWth: posterior wall thickness, EF: ejection fraction
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An electrocardiogram (Fig. 2A) revealed HR of 118/min, atrial fibrillation, low potentials on limb induction, and poor-R wave progression on V1-3 wave. Echocardiography (Fig. 2B, C) revealed a hypertrophic myocardium with high echogenicity.
Pathological findings in the biopsied transbronchial lung biopsy specimens (A). Congo red staining (B, C) and apple green birefringence (D).
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The TBLB specimen of the lower lobes of the right lung showed polypoidal organizing lesions protruding into the alveolar spaces (Fig. 3A); organizing pneumonia (OP) was diagnosed and treatment with steroids was initiated. TBLB specimens, which were stained positive (Fig. 3B, C), and polarized light microscopy revealed apple green birefringence amyloid deposits (Fig. 3D) and diffuse amyloid deposits in the alveolar septum (Fig. 3B). Technetium 99m pyrophosphate scintigraphy revealed the strong accumulation of technetium pyrophosphate in the inferior wall (Fig. 4); amyloid deposition of TTR was positive and mutations with amino acid changes were not observed in the TTR gene.
99mTechnetium pyrophosphate scintigraphy. Accumulation of technetium pyrophosphate in the inferior wall.
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TBLB specimens, which were stained positive (Fig. 3B, C), and polarized light microscopy revealed apple green birefringence amyloid deposits (Fig. 3D) and diffuse amyloid deposits in the alveolar septum (Fig. 3B). Technetium 99m pyrophosphate scintigraphy revealed the strong accumulation of technetium pyrophosphate in the inferior wall (Fig. 4); amyloid deposition of TTR was positive and mutations with amino acid changes were not observed in the TTR gene.
Chest computed tomography following treatment with steroids for organizing pneumonia.
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