Amyloidosis and Pleural Disease: Discussion (Part 1)
Pleural effusions appear to occur not infrequently in patients with systemic amyloidosis, 30 percent in one series. The cause for the pleural efiusions is most often congestive heart failure. Indeed, a large review of 333 patients with systemic amyloidosis from 13 studies revealed that the incidence of histologic involvement of the heart was 66 percent, with 46 percent incidence of clinically evident congestive heart failure, with or without pleural efiusions. Other data suggest that there is a good correlation between cardiac amyloid involvement and the presence of pulmonary involvement. Other explanations for pleural efiusions include liver failure, nephrotic syndrome, and direct pleural deposition with amyloid. buy antibiotics online
Amyloid deposition in the pleura has been demonstrated in ten patients so far (see Table 1), five from prior reports and five patients from the current series. Crystal violet stain and/or Congo red stain viewed under polarized microscopy for apple green birefringence were used in all cases. Percutaneous Cope needle technique was used to obtain pleural tissue and establish the diagnosis in seven of ten patients, five of whom are from the present series. In the remaining patients, either a thoracoscopy or open lung biopsy was used to obtain pleural tissue.
Five of the ten patients with documented pleural involvement with amyloidosis, including three of five patients whose cases are reported herein, clearly have transudative pleural effusions. At least four of the five patients with transudative effusions and pleural involvement with amyloid (Knapp et al, case 2, and patients 1 through 3 of the present series) had clinical evidence for congestive heart failure, and this likely represents the cause for the effusions. The amyloid deposited in the pleura is likely an incidental finding and probably does not play a role in the pathogenesis of the pleural effusions.