PMC9208636_01
Chest X-ray indicated bilateral pulmonary inflammation and pleural effusion.
IMCRJ-15-299-g0001.jpg
PMC9208636_01_IMCRJ-15-299-g0001.jpg
f0001
Chest X-ray showed bilateral pulmonary inflammation with pleural effusion (Figure 1).
ECG showed sinus rhythm, left deviation of ECG axis, QRS low voltage on leads of limb, abnormal Q wave of II, III and AVF, and QRS presented as rS pattern in V1-V6 R.
IMCRJ-15-299-g0002.jpg
PMC9208636_01_IMCRJ-15-299-g0002.jpg
f0002
Electrocardiogram (ECG) indicated low QRS voltage of limb leads, abnormal Q wave of II, III and aVF, and poor increase of V1-V6 R wave (Figure 2). V50M, Val30Met) was detected (Figure 5, Table 2) in TTR genetic sequencing.
(A) Subcostal long-axis view showed the anterior ventricular septum and posterior wall were significantly thickened and a characteristic "granular sparkling" appearance of the thickened cardiac walls. (B) Subcostal 4-chamber view showed the ventricular septum and posterior lateral wall were significantly thickened and a characteristic "granular sparkling" appearance of the thickened cardiac walls. (C) Subcostal short axis view at the level of papillary muscle: all of the basal segments of ventricular wall were significantly thickened with a characteristic "granular sparkling" appearance. (D) The Bull's eye diagram showed reduced global longitudinal strain (GLS) with apical sparing.
IMCRJ-15-299-g0003.jpg
PMC9208636_01_IMCRJ-15-299-g0003.jpg
f0003
Echocardiography revealed cardiac hypertrophy, left ventricular diastolic dysfunction (grade II) and small amount of pericardial effusion (Figure 3). The speckle tracking imaging showed reduced global longitudinal strain (GLS) with apical sparing and with an apical-to-basal strain ratio 2.7 and the ejection fraction (EF) to GLS ratio (EFSR) was 4.4, which were consistent with the ultrasonic characteristics of CA (Figure 3).
Display of chest CT images of the patient. Figure (A-C) were displayed on lung window at the top of the diaphragm at different times. The small calcification shadow on the lung surface at the base of both lungs gradually increased. In additional, they all showed diffuse pulmonary interstitial changes, cystic change and lung consolidation shadows. (D) Mediastinal window on the same plane as figure (A-C): fine sand granular calcification can be seen under the pleura in the lesion of the lower lobe of the left lung, which is clearer than that in the lung window.
IMCRJ-15-299-g0004.jpg
PMC9208636_01_IMCRJ-15-299-g0004.jpg
f0004
Several computed tomography (CT) scans of the chest showed diffuse pulmonary interstitial changes, cystic changes and shadows of lung consolidation, gradually increased shadow of small calcification on the lung surface at the bottom of both lungs, which were typical manifestations of pulmonary amyloid deposition (Figure 4).
TTR gene sequencing: A missense mutation c. 148 G-A (p. V50M, Val30Met) was detected in TTR gene.
IMCRJ-15-299-g0005.jpg
PMC9208636_01_IMCRJ-15-299-g0005.jpg
f0005
V50M, Val30Met) was detected (Figure 5, Table 2) in TTR genetic sequencing.