2025 Volume 47 Issue 5 Pages 444-448
Background. Diffuse alveolar septal amyloidosis is often asymptomatic, and an ante mortem diagnosis is rarely made. We herein report a case of amyloid transthyretin (ATTR) amyloidosis diagnosed using transbronchial lung biopsy despite the absence of abnormal pulmonary shadows. Case. A 74-year-old man with a history of bilateral carpal tunnel syndrome was treated for heart failure and persistent atrial fibrillation. He was suspected of having cardiac amyloidosis due to left ventricular wall thickening and was referred to our hospital. Myocardial biopsy and abdominal fat aspiration biopsy did not lead to a diagnosis, and the patient was referred to our department because of suspected sarcoidosis based on echocardiographic findings in addition to cardiac amyloidosis. Results. Although no significant findings were observed on chest imaging, a transbronchial lung biopsy confirmed the diagnosis of ATTR amyloidosis. Genetic testing was not performed, but the patient's clinical background suggested wild-type ATTR amyloidosis. Conclusion. In cases of suspected systemic amyloidosis, a transbronchial lung biopsy can assist in the diagnosis, even in the absence of pulmonary shadows.
