Download Calcified Plaque in the Superior Portion of the

1:445-48
4 Kalyan-Raman
thy
UP,
causing
Kalyan-Raman
intracranial
K. Cerebral
hemorrhage.
Ann
amyloid
Neurol
angiopa-
1984;
16:321-
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5 Mandybus
TI,
Bates
complicating
RD.
cerebral
Fatal
massive
amyloid
intracranial
angiopathy.
hemorrhage
Arch
Neurol
1978;
35:264-68
6 RoadJD,
JacquesJ,
SparlingJr.
presenting
with
pulmonary
arteries.
7 Colby
WM,
Am
Rev
Dis
CB. Infiltrative
of the
septal
amyloidosis
and medical
Respir
ed.
Pathology
alveolar
hemoptysis
TV Carrington
Publishers,
1985;
dissection
lung disease.
lung.
New
of
132:1368-70
York:
In: Thurlbeck
Thieme
Medical
1988:489-92
8 Walley
VM.
formation.
Amyloid
Arch
9 Rossman
ed.
Diffuse
recurrent
deposition
Pathol
MD.
Lab
Pulmonary
Pulmonary
in a gastric
Med
1986;
arteriovenous
disease
and
arteriovenous
mal-
110:69-71
fistulas.
disorders.
New
In: Fishman
York:
AP,
McGraw-Hill,
1980:883-86
Calcified Plaque in the Superior
Portion of the Major Fissure*
An Unusual
Manifestation
of Asbestos
Exposure
Stephen
F1i;uIeE
3. From
the lobectomy
with mural
amyloid
deposition,
cations
X 40 (tipper)
and
x 200
On
the
other
reported
ectasis,9
hand,
about
to be caused
l)Ut
in OU
specimen
Congo-Red
(lower).
50
showing
the
stain,
original
percent
by hereditary
case,
no
of
AV
fistula
specific
cause
was
are
telangi-
found
P
except
for the massive amyloid
deposits
in the walls of the fistula.
In addition,
the old chest roentgenogram
clearly
demonstrated
that
existence
amyloidosis
of
coincidence,
preceded
amyloidosis
but
yet,
the
and
these
AV
facts
AV
fistula.
fistula
do
The
may
be
Visceral
co-
just
a
suggest
the amyloid
deposition
destroyed
the vascular
the AV fisttala. To or
knowledge,
this is the first reported
case in which pulmonary
amyloidosis
is suspected
of causing
an AV fistula
in the lung.
In otir
case,
the
presence
of multiple
amyloidomas
our attention
to the abnormal
deposition
material
in the fistula wall, but this may
disregarded
if
no
other
lesions
had
therefore
suggest
that amyloidosis
the etiologic
factors when pulmonary
called
of eosinophilic
well have been
been
present.
be suspected
AV fistula
plaque
leural
asbestos,
that
walls to form
strongly
of
is present.
RE FERE
manifestations
NI, Rubinow
ill
100
superior
with
L, Cohen
amyloidosis.
AS.
Bleeding
JAMA
249:1322-24
2 Missen
This
63-year-old
exposure
bladder
1970;
3 O’Drady
senting
1436
iue
Tribe
CR.
to unrecognized
Catastrophic
secondary
hemorrhage
from
amyloidosis.
Br
J
the
Urol
42:43-49
JF,
with
O’Connell
severe
TCJ.
intestinal
Primary
hemorrhage.
systemic
amyloidosis
Ir
J
Med
preSci
1968;
F.C.C.P
sign of exposure
to
the parietal
surface.
on
by interlobar
recognized
ofthe
major
fis-
and
man
fissure.
REPORT
presented
to the
hospital
with
symptoms
pain; subsequent
investigations
revealed
by malignant
histiocytic
lymphoma.
He
to asbestos
had a past
during
history
of chronic
Posteroanterior
and
demonstrated
and
a 40-year
career
plaque
along
cough
chest
hyperinfiated
the
had
as a railroad
nonproductive
lateral
had
worker
and
dyspnea
roentgenograms
lungs
of
vertebral
taken
with peribronchial
right
lateral
chest
in the
midportion
wall
and
of the
right
hemidiaphragms.
A dense
GAK,
involvement,
portion
severe
back
involvement
thickening
1983;
M.D.,
often
CASE
on admission
A, Talarico
patients
most
We
as one
HowardJolles
is a well-recognized
occurring
pleural
on exertion.
‘b(x)d BA, Skinner
and
sure thickening,
is an uncommon
manifestation,’
although
one group2 reports that the incidence
may be higher than is
generally
believed.
The development
of both parietal
and
visceral
plaque
is related
to the duration
of exposure
to
asbestos
dust.
Calcified
visceral
pleural
plaques
are rare.
Those reported
have been in the minor fissured and inferior
portion
ofthe major fissure.5,6
To the best ofour knowledge,
this case report is unique in describing
a calcified
plaque in
the
ACKNOWLEDGMENTS:
We wish to thank
Dr. Yoshinori
Kawabata
for the pathologic
examination,
and also Dr. Toshio
Morohoshi
for
his analysis
ofamyloid
protein.
1
M.D.;t
Parietal
pleural plaque is a well-recognized
sign of exposure
to asbestos.
Visceral
pleural
involvement
is an uncommon
manifestation,
and calcified
visceral
pleural
plaques
are
rare. Those reported
have been in the minor fissure and
inferior
major
fissure.
We describe
a unique
calcified
plaque
in the superior
major fissure.
(Chest 1989; 96:1436-37)
AV fistula
magnifi-
hemorrhagic
B. Rupp,
hemithorax.
*Fmm
ovoid
On
the
mass
the
was
lateral
Department
present
view,
this
of Radiology,
density
projected
Medical
College
of
Fissure
along
the
of Virginia,
Richmond.
tResident
Assistant
in Diagnostic
Radiology.
Professor
of Radiology.
Calcified
Plaque
in Superior
Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21604/ on 05/12/2017
Portion
Major
(Rup
JoNes)
FIGURE
zone
plane
of the major
calcification
(Fig
2).
plaque
fissure
within
On
along
this
additional
the
1. Posteroanterior
On lateral
(left) and
view, note
(arrows).
(Fig 1). A thoracic
mass
slices,
and
CT scan demonstrated
confirmed
there
posterolateral
chest
was
lateral
(right)
that long axis
the
fissural
calcified
walls
also
location
parietal
and
in both
chest
roentgenograms
of mass conforms
pleural
hemidia-
phragms.
been
the
fissure
adjacent
radiographic
findings
and
thickening
in
exposure
occur
to
as
late
asbestos
but
reliable
but
can
also
appear
subsequent
to empyema
and hemothorax.
In the
patient exposed
to asbestos,
routine posteroanterior,
lateral,
and oblique
chest roentgenograms
sometimes
fail to adequately
demonstrate
the
presence
and
extent
of
pleural
involvement
due to the round
nature
of the chest wall.
Computed
tomography
is more sensitive
in the detection
of
pleural
thickening
and of associated
calcification
within
the
plaque and hemidiaphragms.25.7
Calcified visceral pleural plaques are very rarely reported.
Solomon
et al described
two cases ofcalcified
plaque
within
the minor fissure. Calcified
plaques in the major fissure have
to the
of
(both
middle
hemidiaphragm,
plaque
Review
plaques
plaque
inferior
triangular-shaped
mass in right
fissure.
in both
of these cases, the plaque
or dependent
portion
of the major
reported;56
involved
surface.
DISCUSSIoN
Pleural
demonstrate
to plane
of major
with
extending
the
to
previous
calcified
and
the
the
reports
of
noncalcified)
base
of the
diaphragmatic
visceral
pleural
sugjests
that
they
the minor
and inferior
major
fissures
because
the asbestos
fibers are deposited
predominantly in the middle and lower pulmonary
zones.8
The calcified
plaque in the major fissure reported
herein
is unique
in two respects.
First, the lesion is located within
the superior
extent of the major fissure,
rather than in the
dependent
portion.
Also, this plaque is discreetly
separated
from the visceral-parietal
pleural
interface.
The location
is
occur
more
similar
to
commonly
the
In retrospect,
on
the
plain
in
noncalcified
plaque
reported
both
unique
aspects
of this case were
film,
but
the
CT
scan
by
was
Webb
et’
evident
instrumental
in
the diagnosis.
confirming
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FIGURE
settings).
contiguous
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2.
Computerized
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Note
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within
pulmonary
parenchyma
to mass,
corresponding
to major
fissure
(arrows).
On
CT settings,
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calcified
(not shown).
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Mushy
CHEST
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Markovitz
A.
Suhpleural
distinction
from
non-
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