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A 50-year-old Caucasian man was presented to the emergency department with cough and progressive dyspnoea.
Plain chest x-ray showed multiple pseudo-nodular parenchymal opacities, partly confluent and calcified, prominent in the middle-basal lung fields (figure 1A).
Volumetric high-resolution computed tomography (HRCT) confirmed multiple bilateral parenchymal nodules with lobulated margins and extensive calcifications due to diffuse bronchiectasis with thickened and calcified walls (figure 1B–C). Airways involvement was evident, characterised by submucosal deposits and lumen distortion mainly in the trachea, without sparing of the posterior membranous portion, and main and segmental bronchi (figure 2).
Biopsy specimen from bronchoscopy was striking for amyloid (figure 3), therefore the evidence pointed towards a diagnosis of primary tracheo-bronchial amyloidosis.
There are four patterns of thoracic amyloid deposition, well demonstrated on CT: tracheo-bronchial, nodular parenchymal, diffuse alveolar/septal and lymphadenopathies.1
For the tracheo-bronchial form many radiological differential diagnoses should be considered, mainly Wegener's granulomatosis, tracheobronchopathia osteochondroplastica (that typically spares pars membranacea) and relapsing polychondritis.2
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