Briggs James H, Singleton William G, Burke Margaret M, Hart Lorraine A, Parker Robert J
Department of Respiratory Medicine, Heatherwood and Wexham Park Hospitals NHS Foundation Trust, King Edward VII Hospital,Windsor, Berkshire, SL4 3DP, UK.
Cases J. 2009 Jul 21;2:6963. doi: 10.4076/1757-1626-2-6963.
A 66-year-old man with a diagnosis of monoclonal gammopathy of unknown significance was referred for investigation of bilateral transudative pleural effusions by the cardiology team. Echocardiography, myocardial perfusion scanning and left heart catheterisation were all normal or non diagnostic. Given significant occupational asbestos exposure in his twenties he underwent thoracoscopic pleural biopsy. This showed fibrous inflammation only. He subsequently developed proteinuria and peripheral oedema. Reanalysis of the pleural biopsy specimen for amyloidosis was positive. Pleural disease is an uncommon presentation of systemic amyloidosis. The aetiology of the pleural effusions is unclear and is not simply a consequence of cardiac or renal impairment.
一名66岁被诊断为意义未明的单克隆丙种球蛋白病的男性患者，由心脏病学团队转诊来调查双侧漏出性胸腔积液。超声心动图、心肌灌注扫描和左心导管检查均正常或无诊断价值。鉴于他在二十多岁时有大量职业性石棉接触史，他接受了胸腔镜胸膜活检。结果仅显示纤维性炎症。随后他出现蛋白尿和外周水肿。对胸膜活检标本重新进行淀粉样变性分析呈阳性。胸膜疾病是系统性淀粉样变性的一种不常见表现。胸腔积液的病因尚不清楚，并非仅仅是心脏或肾脏损害的结果。
