CTICasesCystic Lung Disease from Pulmonary Light-Chain (Amyloid) Deposition
Imaging findings
A 41-year-old man with known renal amyloidosis (no underlying plasma cell dyscrasia identified) had CT showing scattered, few thin-walled cysts with a perivascular distribution throughout the lungs, without lung biopsy; the cysts were presumed to represent pulmonary involvement by amyloid given the absence of any other explanation.
Key takeaways
Light-chain/amyloid protein deposition, like lymphoid interstitial pneumonia, can cause perivascular thin-walled cystic lung disease, likely through a combination of small airway obstruction by deposited protein and macrophage-mediated digestion/excavation of lung tissue while clearing the protein, so cystic lung disease in a patient with known systemic amyloidosis should be presumed to represent pulmonary amyloid involvement even without a tissue diagnosis from the lung itself.
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