Suspected Pericardial Tuberculosis Revealed as an Amyloid Pericardial Mass

Abstract

Primary systemic amyloidosis is not easily diagnosed. The immunoglobulin deposits are usually localized in the kidney, heart, and liver. We describe an unusual case of a patient suffering from a pericardial amyloidoma with internal calcifications and air bubbles that compressed the right ventricle and shifted the heart to the left. Since the patient was in shock, urgent pericardiotomy was performed. This site showed PET uptake. A monoclonal component was present. On these findings, differential diagnoses included multiple myeloma and atypical pericardial tuberculosis, whereas a periumbilical fat tissue biopsy demonstrated amyloidosis. A previous Salmonella species infection had most likely stimulated the production of amyloid. The patient received bortezomib/dexamethasone treatment and achieved a good response.

Figure 1

Chest CT scan. The mass is compressing the right ventricle and shifting the heart. Pleural effusion is present, with compression of the left lung.

Figure 2

Serum protein electrophoresis before (a) and after (b) therapy. After therapy, there was a reduction of the monoclonal component (1).

Figure 3

Amyloid deposition in periumbilical fat ((a)-Congo red) with apple-green birefringence (b) at polarized microscope analysis.