CTICasesMedullary Thyroid Carcinoma with Bronchial Artery Aneurysms and Cystic Lung Disease (Amyloidosis-related)
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Imaging findings
In 2013, a very large, heterogeneous thyroid mass and multiple heterogeneous, calcified mediastinal and hilar masses were present, extending into the right hilum. Subsequent studies showed residual enhancing lesions in the mediastinum and right hilum that were hyperenhancing and followed blood pool, suggesting bronchial artery aneurysms. Bronchial angiogram confirmed a massive bronchial artery aneurysm with flow into the right lower lobe and left atrium. Additionally, the patient had extensive lung cysts and pulmonary hypertension, and an enlarged right coronary artery.
Key takeaways
The patient had known medullary thyroid carcinoma, and the mediastinal/hilar lesions were initially thought to be metastases. However, their hyperenhancing nature and blood pool follow-up led to the diagnosis of bronchial artery aneurysms. The extensive cystic lung disease is explained by medullary thyroid carcinoma secreting a protein (calcitonin or thyroglobulin, which acts as a substrate for amyloid-like material) leading to amyloidosis and cystic changes, a known but rare association, sometimes seen in MEN syndromes. The cause of the bronchial artery aneurysms and their relation to pulmonary hypertension remains unclear.
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