A Solitary Pulmonary Nodule: Pulmonary Amyloidosis

A 67-year-old male and former smoker was admitted to the hospital because of abdominal pain. An abdominal CT scan revealed not only acute biliary pancreatitis, but also a pulmonary nodule in the right lower lobe (Figure 1). On 18-Fluoro-deoxyglucose (18F-FDG) PET-CT scan the solitary pulmonary nodule posterior in the right lower lobe revealed a high 18F-FDG-uptake (Figure 2). No enlarged or high uptake lymph nodes nor distant metastasis were seen. So far, a malignant tumor was suspected. By CT-guided biopsy of the nodule, a specimen was obtained and revealed necrotic tissue without evidence of malignancy. Mediastinoscopy for mediastinal mapping was performed. All biopsies showed normal lymph node tissue and no malignancy. Finally, a thoracoscopic right bilobectomy was performed. Histopathology of the specimens revealed an amyloid tumor with maximal diameter of 35 mm. Extensive diagnostic work-up for systemic amyloidosis remained negative. The diagnosis of pulmonary amyloidosis was confirmed.