Primary Pulmonary Amyloidosis

Abstract

A 61-year-old male patient was admitted to our hospital with complaints of chest pain and cough for a month. The patient had a history of ischemic heart disease and he worked in carpet washing factory. The patient had a coronary bypass history 3 years ago. Even though the patient does not smoke at the moment, he had 45 pack/years of cigarettes history. Bilateral respiratory voice sounds was coarse and expiration was long on physical examination of the patient. There was no feature in other system examinations. Requested Initial Laboratory Results during apply to a hospital are as follows;WBC:9,29 10e /u3L, Hgb:12,5g /dL, PLT:308 10e /u3L. Due to the patient's complaints of coughing and CRP elevation, 2-week Gemifloxacin 1x1 posology treatment was started. However due to the patient had a 45-years smoking history, to enter differential diagnosis of malignancy and to better identify the lesion, thorax CT was requested. Unenhanced CT examınaton of patients;millimetric fibrotic shrinkage in the apical paracardiac basal segments, and the consolidation area in right middle lobe segments was observed. After antibiotic treatment CT examınaton of patients;60x62 mm space-occupying lesion with malign appearance that is surrounding the right main bronchus was observed in widest part that extending to the trachea(PET-CT SUDmax: 8.2). The EBUS was performed through the enterance of the middle lobe using efficacy of convex probe endobronchial ultrasound. The lesion were sampled by mediastinoscopy, transthoracic fine needle aspiration biopsy and EBUS but a specific diagnosis could not be obtained. Thoracotomy was performed for diagnostic purposes. Interstitial amyloidosis was diagnosed. Hematology consultation was performed. There is no evidence suggesting systemic amyloidosis.