Primary systemic amyloidosis: imaging interpretation of this complex multisystemic disease

Area of Science:

• Medical diagnostics
• Pathology
• Radiology

Background:

• A 63-year-old female presented with cough and dyspnea, exhibiting interstitial lung markings on chest X-ray.
• Initial imaging suggested lymphangitic carcinomatosis, prompting abdominal and pelvic CT scans.

Observation:

• CT revealed septal thickening, omental abnormalities with calcifications, and gastric/duodenal wall thickening.
• Initial biopsies were non-diagnostic; however, endoscopic biopsies showed Congo red positivity, indicative of amyloidosis.

Findings:

• The patient was diagnosed with advanced systemic amyloid light-chain amyloidosis.
• The condition involved diffuse pulmonary, omental, cardiac, and gastrointestinal amyloid deposition.

Implications:

• This case underscores the diagnostic complexities of systemic amyloidosis, particularly when presenting with varied radiological findings.
• It emphasizes the importance of integrating imaging, biopsy, and hematological data for accurate diagnosis.