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1998 Presentations for the Poster and Vignette Sessions
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A MASQUERADING MEDIASTINAL MASS. K. M. Hotton, MD. University of Wisconsin Hospitals and Clinics, Madison, WI

An 82 year old man presented with acute onset right lower chest pain with radiation to the upper back and shortness of breath. Physical exam was remarkable for diminished breath sounds and

dullness to percussion at the right lung base. Pleural fluid was consistent with frank blood. Computed tomography (CT) of the abdomen revealed an 8.5 by 3.5 cm mediastinal mass, which was absent on CT four months earlier. At the patient's request, he was managed conservatively and supported with blood products, but he unfortunately expired on the fourth hospital day. Autopsy revealed an amyloidoma with hemorrhagic dissection into the right pleural cavity. Serum immunofixation demonstrated a biclonal gammopathy of IgG-kappa and IgA-kappa, favoring a diagnosis of primary amyloidosis.

Localized amyloidosis ("amyloidoma") is a rare entity that can affect almost any solid organ. These masses are commonly mistaken for neoplasms, as was true in this case. Amyloidosis is classified according to its chemical composition as AL, primary amyloidosis, or AA, secondary amyloidosis. Secondary amyloidosis may confer a favorable prognosis.

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