0:00

Okay, and I think we have just time for one

0:03

more. So let me do that or I could stop at this

0:06

point and take questions.

0:09

So I think this is probably a quick enough case. So let

0:12

me show you it's an interesting one. This was a 46 year old

0:15

female with a history of asthma obesity and Gerd with

0:18

Disney and cough and gets an hrct.

0:21

So let's check out these CTE

0:24

images takes a few seconds to load. It seems like

0:35

okay, perfect. So just pay

0:39

attention to these hrct images and risks we

0:42

are going you will start noticing several cystic

0:45

lesions most of them associated with this

0:48

kind of a very hyperdense calcific foci.

0:51

And I'll point out a few of these but they're really several of these

0:54

lesions. So here is another one. You can see a very calcific focused related

0:57

with what seems like a long cyst.

1:00

They have bilateral again. There's a

1:03

much bigger lesion here. You can see in the right lower assist with

1:06

the calcific nausea.

1:11

So here are some still images just to ingrain those

1:14

findings again. You have these cystic lesions here with calcific nodules.

1:19

So to summarize the patient had

1:22

multiple lung says calcified nodules associated with

1:25

assists.

1:26

So think about the most likely diagnosis, what would

1:29

you think and again can we have reportedly would it be

1:32

lager hand cell hysterocytosis?

1:34

amyloidosis lip or bertolome

1:40

So the key finding here again to recapitulate assists with

1:43

calcified nodules.

1:47

All right. Let's see the results of the pole. What do we find?

1:52

and most people thought it's Botox syndrome,

1:55

and that's a reasonable consideration because this patient

1:58

has cysts, but actually this finding

2:01

is very very

2:03

Pathognemonic or I

2:06

would say suggestive of amyloidosis and let's see how we come

2:09

to this differential diagnosis.

2:12

So when you think about lung cysts in association with nodules really

2:15

the big things that come to mind are longer hand

2:18

cell historytosis lymphocytic institutional pneumonia

2:21

and amyloidosis. All of these three conditions

2:24

are associated with cysts and nodules.

2:28

Now it doesn't really make sense for langerhans because they typically

2:31

happen with an apple on

2:34

predominance bearing the claustrophenic angle and the cyst shape

2:37

is usually very unusual and bizarre.

2:40

And the other Factor the fact that we they're not

2:43

associated with calcified nodules, but rather nodules in

2:46

various stages of cavitation. So that doesn't really make sense for

2:49

our case.

2:50

If we go to lip, it usually happens in a

2:53

very specific setting so there is usually some kind

2:56

of autoimmune process particularly Shoguns, but others

2:59

can happen as well. They can be infections like HIV. In

3:02

fact, it's an AIDS defining illness in children.

3:05

All very rarely it might be rare idiopathic.

3:09

So lip again the absence of that setting and the presence

3:12

of these calcified nodules doesn't really make sense for lip

3:15

either.

3:17

This is in fact a case of lip that was a patient

3:20

with HIV and had all these multiple cysts and

3:23

several nodules scattered throughout the long. So this is a proven case

3:26

of an IP. Just wanted to show your companion case.

3:30

But going back to our case cysts with calcified. Lung

3:33

nodules should really make us think about amyloid Associated

3:36

cystic lung disease.

3:39

So, in fact this patient amyloid was

3:42

not suspected prior to the Chastity. It was a totally unsuspected

3:45

diagnosis. But once we suggested it the

3:48

patient had lab evaluation, and he was finally confirmed to

3:51

have amyloid.

3:55

And this is another patient with amyloid and you can see has

3:58

multiple lung cysts and they had also.

4:01

Multiple calcified nodules such

4:04

as this one seen here and this was a proven case

4:07

of amyloid biopsy proven.

4:09

Okay, I think I will probably stop at this

4:12

point. Thank you very much. It was indeed my pleasure

4:15

to participate in this.

4:17

Have a good day everyone.