PMC4007783_01
(a) Cardiac MRI shows diffuse infiltration with endomyocardial fibrosis including interatrial septum. Pericardial and pleural effusions demonstrate heart failure. (b) Diffuse and global pattern of late gadolinium enhancement that matches the distribution of amyloid on histology (also exits enhancement at interauricular septum).
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fig1
After gadolinium administration was observed, a diffuse, delayed, and faint enhancement involving all four chambers predominantly in subendocardial areas, findings which are clearly correlated with an infiltrative process and very suggestive of cardiac amyloidosis (Figure 1).
PMC4007783_02
(a) Pulmonary parenchyma with amyloid deposition showed by Congo red staining. 10x. (b) The same image but negative for amyloid immunochemistry. 10x.
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fig2
The pathologic study identified extracellular amyloid deposits by Congo red staining and viewing under polarized light where amyloid deposits produce a distinctive apple-green birefringence (Figure 2).