Incidental multiple adenopathies and the diagnosis of systemic amyloidosis

Abstract

This report describes the clinical case of a 67-yearold man with hypertension referenced to the medical consultation for the study of several bilateral mediastinal adenopathies discovered accidentally on a chest computed tomography (CT) following the patient’s admission to the emergency department after falling off a tree. Of note in the physical examination is the presence of macroglossia and thick lips (Figure 1A). In the complementary study of adenopathies serologic data and a positron emission tomography (PET) scan were requested. Analytically with a sedimentation rate of 21 mm, the peripheral blood smear analysis was normal and there was a good renal function with no change in phosphocalcic metabolism. At the level of immunoglobulins, a value of IGG-2300 mg/dl was found with the respective gamma-monoclonal peak (IGG-lambda) in the electrophoresis allowing the diagnosis of monoclonal gammopathy of undetermined significance. Posteriorly, PET scan demonstrated additional cervical and mediastinum-hilar bilateral ganglia with low metabolic activity of inflammatory nature, without suggestive alterations of tumor lesions with significant hypermetabolism of 18F-FDG (Figure 1B, Figure 1C). The definitive diagnosis of primary amyloidosis was obtained later through abdominal fat biopsy (Figure 1D). An echocardiogram was requested to rule out the cardiac involvement of the disease. Given the clinical stability of the patient and the absence of significant findings in the complementary diagnostic tests, the strategy adopted in this patient was “watch and see.”