An uncommon cause of bilateral pulmonary nodules in a long-term smoker.
BACKGROUND
Dyspnea caused by pulmonary disease is a common symptom encountered by internists. The most likely diagnosis of pulmonary nodules in a long-term smoker is lung cancer. PATIENT/PARTICIPANT: We report a case of an elderly male with a 70-pack-year smoking history, presenting with exertional dyspnea for 6 months.


METHODS
Detailed review of history was negative. Examination was normal except for diminished breath sounds in all lung fields. Chest x-ray showed bilateral nodular opacities. Computed tomography of thorax revealed multiple bilateral lung masses. A whole-body positron emission tomography revealed enhancement only of the pulmonary masses. Bronchoalveolar lavage was negative for acid fast bacilli, nocardia, and fungi.


RESULTS
Lung biopsy showed findings consistent with amyloidosis. Bone marrow biopsy done to investigate primary amyloidosis showed no clonal plasma cells or amyloid staining, thus suggesting a diagnosis of localized pulmonary amyloidosis. Patient is being managed conservatively with close follow-up for signs of progression.
Gaurav
Kumar
K
Department of Medicine, University of Tennessee, College of Medicine-Chattanooga Unit, 975 East Third St., P.O. Box 94, Chattanooga, Tennessee 37403, USA. doctorkumargaurav@yahoo.com
Panda
Mukta
M
D000368:Aged; D000686:Amyloidosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D018893:Bronchoalveolar Lavage; D015897:Comorbidity; D003937:Diagnosis, Differential; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D008297:Male; D012907:Smoking / Q000453:epidemiology; D036542:Tomography, Spiral Computed