title: Three cases of systemic amyloidosis successfully diagnosed by subcutaneous fat tissue biopsy of the hip.
abstract: Fine-needle aspiration biopsy of the abdominal fat pad is considered to be a minimally invasive procedure for diagnosing systemic amyloidosis. However, this procedure is sometimes difficult and can be dangerous for elderly patients whose abdominal fat layer is thin because of malnutrition. In such cases, alternative diagnostic methods are required. We report three elderly patients with heart failure complicated by malnutrition. In all cases, electrocardiogram showed low voltage in the limb leads and a pseudoinfarct pattern in the chest leads, and echocardiography showed left ventricular wall thickening with granular sparkling appearance. These patients were suspected of having amyloid cardiomyopathy but could not undergo myocardial biopsies because of their poor conditions. After failed attempts at biopsy of the abdominal fat pad or the other organs, subcutaneous fat tissue biopsy over the hip led to the diagnosis of systemic amyloidosis with cardiomyopathy. The resultant diagnosis guided us to choose the appropriate treatment for the patients. This article illustrates that subcutaneous fat tissue biopsy of the hip could be a useful procedure for diagnosing systemic amyloidosis in elderly patients, particularly when a fat tissue biopsy of the abdomen is associated with a high risk of complications because of malnutrition.
authors.affiliation: Department of Internal Medicine, Nanto Municipal Hospital, Nanto.
authors.forename: Masahisa
authors.initials: M
authors.lastname: Arahata
authors.affiliation: Department of Internal Medicine, Nanto Municipal Hospital, Nanto.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Shimadoi
authors.affiliation: Department of Internal Medicine, Nanto Municipal Hospital, Nanto.
authors.forename: Satosi
authors.initials: S
authors.lastname: Yamatani
authors.affiliation: Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama.
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama.
authors.forename: Shigeharu
authors.initials: S
authors.lastname: Miwa
authors.affiliation: Department of Internal Medicine (III).
authors.forename: Hidesaku
authors.initials: H
authors.lastname: Asakura
authors.affiliation: Department of Cellular Transplantation Biology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nakao
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000368:Aged; D000369:Aged, 80 and over; D000686:Amyloidosis / Q000175:diagnosis* / Q000473:pathology; D044963:Biopsy, Fine-Needle; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000473:pathology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D050507:Subcutaneous Fat, Abdominal / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: abdominal fat pad; amyloid cardiomyopathy; fine-needle aspiration biopsy; hip; subcutaneous fat tissue; systemic amyloidosis