IJCHV-00039; No of Pages 2 IJC Heart & Vessels xxx (2014) xxx–xxx
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Cardiac amyloidosis incidentally detected using technetium-99 m hydroxymethylene diphosphonate bone scintigraphy in a patient with prostate cancer
Keywords: HMDP Heart failure Cardiomyopathy Biopsy
A 73-year-old man with prostate cancer had undergone bone scintigraphy with technetium-99 m hydroxymethylene diphosphonate (99mTc-HMDP) to detect metastasis, and he was referred to us from the urology department because of abnormal cardiac accumulation. In general, 99mTc-HMDP scintigraphy showed no cardiac accumulation (Fig. 1A). However, the patient exhibited significant uptake in the heart (Fig. 1B), especially in the anterior, septal, and inferior walls on the short axis (Fig. 1C) and horizontal views (Fig. 1D). His family history was unremarkable. He has been treated for hypertension and dyslipidemia for 20 years and did not have cardiac symptoms. Transcatheter coronary angiography showed no significant coronary artery stenosis. Left ventricular endomyocardial biopsy revealed hypertrophied cardiomyocytes with a disordered arrangement and extracellular deposition of pale eosinophilic homogenous amorphous materials on hematoxylin and eosin staining (Fig. 2A). The amorphous materials stained positively with Congo red and were confirmed to be amyloid fibrils (Fig. 2B). The patient was diagnosed with cardiac amyloidosis. Chemotherapy for prostate cancer was initiated, and we carefully followed the patient for early detection of heart failure-related events. In the present case, cardiac accumulation was incidentally detected with bone scintigraphy, leading to the diagnosis of cardiac amyloidosis. The usefulness of bone scintigraphy has been reported in some literatures [1–6]. Whereas, the differential diagnosis of cardiac accumulation by bone scintigraphy includes previous myocardial infarction, hyperparathyroidism, and benign myocardial uptake; the diagnostic sensitivity of this finding in cardiac amyloidosis is not sufficiently high to warrant patient screening [7]. However, this case suggests detailed cardiac examinations should be performed at least when cardiac abnormal accumulation is observed on bone scintigraphy.
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Satoshi Okayama⁎ Masashi Sugimoto Tomoya Nakano Kenji Onoue Yasuhiro Sakaguchi Shiro Uemura Yoshihiko Saito First Department of Internal Medicine, Nara Medical University, Japan ⁎Corresponding author at: First Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634–8522, Japan. Tel.: +81 74 422 3051; fax: +81 74 422 9726. E-mail address:
[email protected]. 20 April 2014 Available online xxxx
☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation. ☆☆ Acknowledgement of grant support: This work was supported in part by grants-inaid from the Ministry of Health, Labor, and Welfare of Japan, and Takeda Science Foundation. ★ Any potential conflicts of interest; None.
http://dx.doi.org/10.1016/j.ijchv.2014.04.010 2214-7632/© 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).
Please cite this article as: Okayama S, et al, , IJC Heart & Vessels (2014), http://dx.doi.org/10.1016/j.ijchv.2014.04.010
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Fig. 1. Bone scintigraphy with technetium-99 m hydroxymethylene diphosphonate shows no cardiac accumulation (A). However, significant uptake can be observed in the heart (B), especially in the anterior, septal, and inferior walls on the short axis (C) and horizontal views (D).
Fig. 2. Left ventricular endomyocardial biopsy shows hypertrophied cardiomyocytes with a disordered arrangement and extracellular deposits of pale eosinophilic homogenous amorphous materials on hematoxylin and eosin staining (A). The amorphous materials stained positively with Congo red and were confirmed to be amyloid fibrils (B) (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.).
Please cite this article as: Okayama S, et al, , IJC Heart & Vessels (2014), http://dx.doi.org/10.1016/j.ijchv.2014.04.010
