AN UNUSUAL CAUSE OF PERIPHERAL LUNG NODULE - NODULAR PULMONARY AMYLOIDOSIS | Dr.v. Nagarjuna Maturu

AN UNUSUAL CAUSE OF PERIPHERAL LUNG NODULE - NODULAR PULMONARY AMYLOIDOSIS

Cone Beam CT guided Biopsy

70-year-old female patient, known case of hypertension and well controlled type 2 diabetes mellitus presented with complaints of cough since 2 months. She had unintentional weight loss of 4kgs over the last year. Her symptoms did not improve with symptomatic treatment and inhalers.

HRCT chest performed for further evaluation revealed a 2.1 x 2 cm nodule in right upper lobe, and smaller nodules in the right lower lobe.

Under general anesthesia and lung navigation ventilation protocol ‘Cone Beam Computed Tomography’ was performed. The lesion was identified in the right upper lobe posterior segment and marked. Radial EBUS was performed, but no lesion was identified.

Using 3 dimensional augmented fluoroscopy a 1.1mm mini cryoprobe was placed abutting the lesion. A repeat CBCT spin showed the cryo probe to be in contact with the lesion. Multiple Cryobiopsies were then performed under augmented fluoroscopy and sent for analysis.

Histopathological examination revealed pale, hyalinized, eosinophilic material surrounded by multinucleated giant cells and lymphoplasmacytic cells. This material was found to be congo red positive with apple green birefringence on polarizer.

Final diagnosis: ‘Pulmonary Nodular Amyloidosis’

TAKE HOME MESSAGES

1. CBCT can help confirming tool adjacent to lesion even in instances where radial EBUS doesn't show an image (index case)

2. Primary pulmonary amyloidosis presenting as lung nodules is uncommon and needs to be considered as an uncommon differential of lung nodule

#PulmonaryAmyloidosis #LungNodule #CBCT #Cryobiopsy #RadialEBUS #Histopathology #RareDiseases #MedicalImaging #LungHealth #drvnagarjunamaturu #pulmonologist #YashodaHospitals #hitechcity