False positive technetium-99m pyrophosphate scintigraphy in a patient with cardiac amyloidosis light chain: Case report.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
30 Apr 2021
30 Apr 2021
Historique:
received:
18
12
2020
accepted:
31
03
2021
entrez:
28
4
2021
pubmed:
29
4
2021
medline:
5
5
2021
Statut:
ppublish
Résumé
Patients with cardiac amyloidosis light chain (AL) present with negative Tc-99m pyrophosphate (PYP) scintigraphy (absent or mild heart uptake). On the contrary, patients with cardiac amyloidosis transthyretin (ATTR) present with positive Tc-99m PYP scanning (intensive heart uptake). We present a false positive Tc-99m PYP scintigraphy (grade 2, the heart-to-contralateral ratio is 1.65) in a patient with AL. A 42-year-old Chinese man complained of effort intolerance, chest discomfort, and short of breath progressively over 1 year. New York Heart Association Class III. Physical examination showed legs swelling. Laboratory revealed elevated brain natriuretic peptide of 23,031 ng/mL (0-88) and Troponin-T of 273.4 ng/mL (0-14). Cardiac amyloidosis light chain. Evidences: free light chains (FLCs): decreased serum free kappa/lambda ratio of 0.043 (0.31-1.56). Immunofixation electrophoresis: a positive lambda light chain monoclonal protein. Cardiac biopsy: HE: Ambiguity Congo red strain. Myocardial immunofluorescence: positive lambda light chain. Myocardial immunohistochemistry: positive lambda light chain, negative kappa light chain, and TTR. Furosemide 40 mg qd, torasemide 20 mg qd, spirolactone 20 mg qd, potassium chloride 10 mL per 500 mL urine, atorvastatin calcium tablet 20 mg qd, aspirin enteric-coated tablets 100 mg qd during the 2-weeks in-hospital. The patient died 2 months later after discharge. False positive Tc-99m PYP scintigraphy may rarely presented in patients with cardiac amyloidosis light chain. So, the clonal plasma cell process based on the FLCs and immunofixation is a base to rule out AL cardiac amyloidosis when we interpret a positive Tc-99m PYP scintigraphy.
Identifiants
pubmed: 33907108
doi: 10.1097/MD.0000000000025582
pii: 00005792-202104300-00023
pmc: PMC8084032
doi:
Substances chimiques
Radiopharmaceuticals
0
Technetium Tc 99m Pyrophosphate
5L76I61H2B
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25582Subventions
Organisme : Sichuan Province Science and Technology Support Program
ID : 20ZDYF2760
Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Wechalekar AD, Gillmore JD, Hawkins PN. Systemic amyloidosis. Lancet 2016;387:2641–54.
Martinez-Naharro A, Hawkins PN, Fontana M. Cardiac amyloidosis. Clin Med (Lond) 2018;18:s30–5.
Dorbala S, Ando Y, Bokhari S, et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: part 1 of 2-evidence base and standardized methods of imaging. J Nucl Cardiol 2019;26:2065–123.
Dorbala S, Ando Y, Bokhari S, et al. ASNC/AHA/ASE/EANM/HFSA/ISA/SCMR/SNMMI expert consensus recommendations for multimodality imaging in cardiac amyloidosis: part 2 of 2-Diagnostic criteria and appropriate utilization. J Nucl Cardiol 2020;27:659–73.
de Miguel C, Llorente L, de Haro-Del Moral FJ, et al. Myocardial uptake of (99m)Tc-DPD in patients with AL amyloidosis. Amyloid 2017;24:48–9.
Persia-Paulino YR, Cuevas-Perez J, Fernandez-Asensio R, et al. Unusual high 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) tracer deposition on a heart scintigraphy in a patient with AL amyloidosis: a case report. J Nucl Cardiol 2020;10.1007/s12350-020-02107-2.
doi: 10.1007/s12350-020-02107-2
Galat A, Van Der Gucht A, Colombat M, et al. (99m)Tc-HMDP scintigraphy rectifies wrong diagnosis of AL amyloidosis. J Nucl Cardiol 2015;22:853–7.
Stats MA, Stone JR. Varying levels of small microcalcifications and macrophages in ATTR and AL cardiac amyloidosis: implications for utilizing nuclear medicine studies to subtype amyloidosis. Cardiovasc Pathol 2016;25:413–7.
Manwani R, Page J, Lane T, et al. A pilot study demonstrating cardiac uptake with 18F-florbetapir PET in AL amyloidosis patients with cardiac involvement. Amyloid 2018;25:247–52.
Genovesi D, Vergaro G, Giorgetti A, et al. [18F]-Florbetaben PET/CT for differential diagnosis among cardiac immunoglobulin light chain, transthyretin amyloidosis, and mimicking conditions. JACC Cardiovasc Imaging 2020;10.1016/j.jcmg.2020.05.031.
doi: 10.1016/j.jcmg.2020.05.031