Volume 134, Issue 2, Pages (August 2008)

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Volume 134, Issue 2, Pages 460-464 (August 2008) A 73-Year-Old Woman With Mild Shortness of Breath and Multiple Central Calcified Pulmonary Nodules Rani Kumaran, MD, Anthony Saleh, MD, FCCP, Bijal Amin, MD, Suhail Raoof, MD, FCCP CHEST Volume 134, Issue 2, Pages 460-464 (August 2008) DOI: 10.1378/chest.07-1955 Copyright © 2008 The American College of Chest Physicians Terms and Conditions

Figure 1 The posteroanterior chest radiograph showing bilateral multiple pulmonary nodules. The nodules vary in size from 0.5 to 3 cm. The nodules show lobulated and irregular margins. CHEST 2008 134, 460-464DOI: (10.1378/chest.07-1955) Copyright © 2008 The American College of Chest Physicians Terms and Conditions

Figure 2 Noncontrast axial CT scan images of the chest (lung window and mediastinal window) at the level of the upper lobes. The dominant nodule in the right upper lobe (bottom, b) is peripheral, lobulated, and noncalcified. The dominant nodule in the left upper lobe (bottom, b) is central, lobulated, and predominantly calcified. There are other smaller, multiple nodules seen bilaterally. CHEST 2008 134, 460-464DOI: (10.1378/chest.07-1955) Copyright © 2008 The American College of Chest Physicians Terms and Conditions

Figure 3 Wedge biopsy of left upper lobe nodule by video-assisted thoracoscopy surgery. Top, a: histology at low power (hematoxylin-eosin, original × 4). At low power, there are nodular deposits of homogenous eosinophilic material. A lymphoplasmacytic infiltrate is noted at the periphery of the nodules. The eosinophilic nodules stain strongly with Congo red, supporting a diagnosis of amyloidosis. Immunohistochemical staining for amyloid protein A is negative, indicating primary amyloidosis. Bottom, b: histology at high power (Congo red stain under polarized light, original × 40). Under polarized light, Congo red-stained nodular deposits shows characteristic apple-green birefringence characteristic of amyloidosis. CHEST 2008 134, 460-464DOI: (10.1378/chest.07-1955) Copyright © 2008 The American College of Chest Physicians Terms and Conditions