CHEST Guidelines-A-70-Year-Old-Man-With-Large-Cervical-and-Mediasti (1)

A-70-Year-Old-Man-With-Large-Cervical-and-Mediasti (1)

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In the case study outlined in "Chest Imaging and Pathology for Clinicians," a 70-year-old man was evaluated for enlarged cervical and mediastinal lymph nodes. Initially, the patient experienced atypical chest pain and weakness but did not show symptoms like fever or night sweats. Basic laboratory tests and pulmonary function were mostly normal. Imaging revealed soft tissue prominence in the suprahilar and subcarinal regions, with CT scans showing multiple enlarged lymph nodes with fine calcification. Initial differential diagnosis considered conditions like sarcoidosis, TB, lymphoma, and various infections.<br /><br />Bronchoscopy and needle aspiration of lymph nodes did not reveal malignancy. Surgical biopsy of the lymph node revealed amorphous eosinophilic material consistent with amyloid. Further tissue analysis confirmed immunoglobulin light chains typical of primary amyloidosis localized to pulmonary lymph nodes, with no systemic involvement.<br /><br />Amyloidosis refers to a group of diseases marked by extracellular deposition of amyloid proteins. These can affect multiple organs or be localized, most commonly impacting the lungs via tracheobronchial amyloidosis. AL (primary) amyloidosis is an acquired condition involving immunoglobulin light chain deposits, while AA (secondary) amyloidosis results from chronic inflammation.<br /><br />The patient's management involved conservative monitoring given the localized nature of the amyloidosis and good response to dexamethasone for symptoms. His latent TB was also addressed with isoniazid for nine months. Amyloidosis diagnosis is complex due to its nonspecific presentation, necessitating careful pathological analysis and biopsy to distinguish and confirm it. Various imaging techniques, including CT and PET scans, aid in evaluating amyloid deposits' extent and nature. Treatment options vary from observation to aggressive interventions, depending on amyloidosis type and progression.

Keywords

amyloidosis

lymph nodes

imaging

biopsy

immunoglobulin

pulmonary

dexamethasone

CT scans

localized

diagnosis