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<v ->We move on and the next stop we make is in amyloid.

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And amyloid I've seen a lot of cases through the years

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but fewer cases in the last five years.

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Most of the cases that I have seen have been related

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to hemodialysis, but amyloid can occur on its own,

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and also can be associated with multiple myeloma.

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Amyloid produces masses in joints and around joints.

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And so it has some very characteristic appearances

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for example, when you get masses around the shoulder,

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the term shoulder pads sign is often used

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because it looks like the shoulder pads,

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that we see in the American football players.

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When it occurs about the wrist, it often leads

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to a mass that produces Carpal tunnel syndrome.

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So that's a common known clinical finding

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in patients with amyloid.

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When it involves joints that erode bone,

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pathologic fractures may occur,

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and one of the interesting aspectS

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is a destructive spondyloarthropathy at one or more levels

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looking a lot like a disc or vertebral infection.

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So, there are a lot of different imaging findings,

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not just with MR, but with conventional radiography

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and CT as well.

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This is one of the conditions that can have areas

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of low signal even on fluid sensitive

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T2-weighted MR Images, let me show you a couple of cases.

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So this is an old case sent to me by one of our previous

1:45

visiting scholars from Austria of amyloid,

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a primary amyloid, and you can see the arrows pointing

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to these masses located mainly behind the knee,

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you'll note here, as we look at T1

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and then a fluid sensitive sequence

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that the masses are mainly of low signal.

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So amyloid should be added

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to a list of tissue that can be associated

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with low signal on fluid sensitive sequences.

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Here's another example, showing you the shoulder pad sign

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with amyloid deposition in and around the versa

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extending into the joint and into the humerus.

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And in the same patient here, you can see,

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in fact, amyloid involving the compartments of the wrist,

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as well as the area of the Carpal tunnel,

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and Carpal tunnel syndrome obviously well recognized.

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Another example given to me by one of my associates,

2:49

Eddie Smitherman showing you at this mass like deposition

2:54

of amyloid on the volar aspect of the wrist

2:58

shown by the black arrows here, you can understand

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why Carpal tunnel syndrome could be a complication.

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And another one sent by one of our prior fellows,

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this is amyloid deposition within that bursa

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that we talked bicipitoradial bursa

3:18

about the biceps tendon note

3:21

that in these sequences, low signal dominates.

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So again, I would emphasize that as a feature of amyloid.

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The other aspect of amyloid that is interesting

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is the infiltration into soft tissue, such as tendon.

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So in large amounts tendons in any particular site,

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along with gout which can also do that,

3:45

you ought to consider amyloid.

3:47

Here's an example with marked enlargement

3:50

of the subscapularis tendon, masses around it,

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and I've certainly seen a few cases

3:56

that have looked like that.

3:58

And then one of the most interesting manifestations

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I've seen with amyloid is involvement

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of joint capsules and capsular ligaments.

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And I've seen that particularly about the hips

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as in the case I'm showing you here,

4:14

where there's bilateral involvement

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and mass like enlargement of the capsule,

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and capsular ligaments.

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Gout can also do this certainly something to think about,

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and other lymphoma and things of that sort can also lead

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to infiltration of joint capsules and tendons.

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So there is a bit of a differential.