Amyloidosis and Pleural Disease: Discussion (Part 2)
All patients had unequivocal evidence for systemic amyloidosis by demonstrating amyloid deposition in at least one other organ system. Seven of nine patients in whom the cause of amyloidosis has been established, including four of five patients from our series, had primary amyloidosis related to plasma cell dyscrasia. This has been well described in the literature in that patients with pulmonary involvement with amyloidosis usually have the primary amyloid L (AL) type where the protein is composed of immunoglobulin light chain components. The conventional diagnostic evaluation for the cause of a pleural effusion involves classifying the effusion as either an exudate or transudate. If the effusion is exudative and of indeterminate etiology, especially with a lymphocytic predominance, pleural biopsy is usually recommended to exclude a malignant neoplasm and granulomatous disease. However, when the pleural fluid is a transudate, it is assumed that the primary disease process is outside the pleural space and closed pleural biopsy is never recommended. buy ortho tri-cyclen online
Biopsy is required to establish the diagnosis of amyloidosis. Biopsy of a clinically affected organ such as kidney, liver, myocardium, and sural nerve is a direct approach and yields the correct diagnosis in 90 percent of the cases. However, these methods are invasive, expensive, and carry some degree of morbidity. Other indirect methods such as bone marrow biopsy, rectal biopsy, and subcutaneous fat aspiration are simpler and have diagnostic yields that range from 30 percent to 72 percent. Percutaneous biopsy of the pleura has never previously been advocated as a biopsy procedure to establish the presence of systemic amyloidosis.