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1:445-48 4 Kalyan-Raman thy UP, causing Kalyan-Raman intracranial K. Cerebral hemorrhage. Ann amyloid Neurol angiopa- 1984; 16:321- 29 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 REFERENCES 1 Webb WR, mimicking J Comput 2 Kagan C, a lung nodule Assist Tomogr E, Schwartz Visceral and Coper pleural Gamsu C. thickening pleural with pla(lsie asbestos exposure. 7: 135-36 1983; A, Kriehel implications Interlohar in a patient D, lix \V, Rohatgi in asbestos of thickened P, Rockoff exposure: interlohar the fissures. SD. occurrence J Thorac Irnag 1987; 2:58-66 3 Solomon ES. Visceral pleura 4 Solomon A, Sluis-Cremer plaque formation in asbestosis. Environ Res 1976; 11:128-34 5 Rockoff SD. due to asbestos 6 Sargent plaques. 7 Sargent FIGURE settings). contiguous mediastinal 2. Computerized tomographic scan (pulmonary window Note band of oligemia within pulmonary parenchyma to mass, corresponding to major fissure (arrows). On CT settings, mass was densely calcified (not shown). EN, CT Felton in patients calcified pleural ed. St. Barnes Calcified pleural 19:258-64 fissure Assist Tomogr LT Visceral 1979; calcification 1987; 11:1066-68 interlobar pleural 1981; 140:634 WD, Balls exposured plaques. M. Lung, Pathology B. Res of interlobar J Comput JS, Boswell fat pads 8 Millard Goldstein Environ demonstration exposure. Radiology EN, GK, in asbestosis. pleura, Louis: P\V, to asbestos: Radiology and CV mediastinum. Mushy CHEST Downloaded From: http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/21604/ on 05/12/2017 1984; I 96 Co, Markovitz A. Suhpleural distinction from non- 152:273-77 In: Anderson WAD, 1971:932 I 6 I DECEMBER, 1989 1437