CTICasesSeptal Amyloidosis
Imaging findings
Chest CT shows coarse reticulation and septal thickening concentrated at the periphery of the lung bases. Soft tissue windows and maximum intensity projection (MIP) reconstructions reveal numerous tiny punctate calcifications and ossifications strung along the thickened interlobular septa. Unlike dendriform pulmonary ossification, which is typically found in a central distribution related to chronic aspiration, these calcifications are located along the peripheral and basal interlobular septa.
Key takeaways
Pulmonary amyloidosis can present in multiple distinct radiologic patterns, including nodular, diffuse alveolar septal, and tracheobronchial forms. The diffuse alveolar septal form is characterized by basal-predominant, peripheral septal thickening mimicking interstitial lung disease, often accompanied by fine punctate calcification or ossification within the septa. This form is typically indolent but warrants screening for systemic light-chain disease or underlying plasma cell dyscrasia.
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