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Case Reports
. 2007 Nov;22(11):1617-20.
doi: 10.1007/s11606-007-0324-z. Epub 2007 Sep 12.

An uncommon cause of bilateral pulmonary nodules in a long-term smoker

Kumar Gaurav  1 , Mukta Panda
Affiliations
Case Reports

An uncommon cause of bilateral pulmonary nodules in a long-term smoker

Kumar Gaurav et al. J Gen Intern Med. 2007 Nov.

Abstract

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.

Interventions: 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.

Main 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.

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Figures

Figure 1
Figure 1
Chest x-ray showing bilateral ill-defined nodular opacities (arrows)
Figure 2
Figure 2
Spiral computed tomography of thorax showing soft tissue lung mass (arrow)
See this image and copyright information in PMC

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