Khoo Hau Wei, Ding Cristine S L, Tandon Ankit Anil
Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.
Department of Pathology, Tan Tock Seng Hospital, Singapore, Singapore.
Am J Case Rep. 2018 Nov 24;19:1398-1404. doi: 10.12659/AJCR.911212.
BACKGROUND Amyloid arthropathy and myopathy are complications of amyloidosis that can be associated with non-specific imaging findings, which may be challenging to interpret. The report is of a case of polyarticular amyloid arthropathy and myopathy in a 56-year-old man with multiple myeloma and includes a description of the radiographic, computed tomography (CT), and magnetic resonance imaging (MRI) findings. CASE REPORT A 56-year-old man with multiple myeloma presented with chronic polyarticular pain and swelling. Soft tissue thickening of the wrist and knee were found on MRI to be of intermediate T1 weighted imaging (T1WI) and low to intermediate T2 weighted imaging (T2WI) signal intensity. Denervation muscle edema seen in the thenar muscles on the MRI of the right wrist were associated with carpal tunnel syndrome secondary to amyloid deposition. Soft tissue lesions in the periarticular regions of both hip joints were contiguous with subchondral bone lesions. Diffusely scattered myeloma lesions were shown as hyperintense on short tau inversion recovery (STIR) MRI imaging throughout the appendicular and axial skeleton, with vertebral compression fractures. Bilateral iliopsoas involvement with hypertrophy and abnormal surrounding fat reticulated signal intensity was consistent with amyloid myopathy. The patient had a pathological fracture of the right femoral neck and underwent surgical fixation. Histology of the right femoral head confirmed amyloid deposits. CONCLUSIONS Because the clinical presentation and imaging findings of musculoskeletal amyloidosis can be nonspecific, they can result in delay in diagnosis and treatment. Early radiologic identification of polyarticular amyloid arthropathy and myopathy should prompt confirmatory biopsy to confirm the diagnosis.
淀粉样关节病和肌病是淀粉样变性的并发症，可能伴有非特异性影像学表现，这可能难以解释。本文报告了一例56岁患有多发性骨髓瘤的男性的多关节淀粉样关节病和肌病病例，并描述了X线、计算机断层扫描（CT）和磁共振成像（MRI）的表现。病例报告：一名患有多发性骨髓瘤的56岁男性出现慢性多关节疼痛和肿胀。MRI显示腕部和膝部软组织增厚，在T1加权成像（T1WI）上呈中等信号强度，在T2加权成像（T2WI）上呈低至中等信号强度。右腕MRI显示鱼际肌失神经肌肉水肿，与淀粉样沉积继发的腕管综合征有关。双侧髋关节周围软组织病变与软骨下骨病变相连。在短tau反转恢复（STIR）MRI成像上，整个四肢和中轴骨骼弥漫性散在的骨髓瘤病变呈高信号，伴有椎体压缩骨折。双侧髂腰肌受累伴肥大，周围脂肪网状信号强度异常，符合淀粉样肌病表现。该患者右股骨颈病理性骨折并接受了手术固定。右股骨头组织学检查证实有淀粉样沉积。结论：由于肌肉骨骼淀粉样变性的临床表现和影像学表现可能不具有特异性，可能导致诊断和治疗延迟。早期通过放射学识别多关节淀粉样关节病和肌病应促使进行确诊性活检以明确诊断。
