A case of intramural coronary amyloidosis associated with hemodialysis
Autops. Case Rep
;
7(1): 13-15, Jan.-Mar. 2017. ilus
Article
Dans Anglais
| LILACS
| ID: biblio-905123
ABSTRACT
Dialysis-related amyloidosis predominantly occurs in osteo-articular structures and dialysis-related amyloid (DRA) substances also deposit in extra-articular tissues. Clinical manifestations of DRA include odynophagia, gastrointestinal hemorrhage, intestinal obstruction, kidney stones, myocardial dysfunction, and subcutaneous tumors. The pathological characteristics of DRA in the heart of hemodialysis patients have rarely been reported. We report the case of a 73-year-old female with a history of cerebral palsy and end-stage renal disease status post two failed renal transplants who had been on hemodialysis for 30 years. The patient was admitted with the working diagnosis of pneumonia. An echocardiography showed markedly reduced biventricular function manifested by low blood pressure with systolic in the 70s and elevated pulmonary artery pressure of 45 mmHg, which did not respond to therapy. Following her demise, the autopsy revealed bilateral pulmonary edema and pleural effusions. There was cardiac amyloid deposition exclusively in the coronary arteries but not in the perimyocytic interstitium. Amyloids were also found in pulmonary and intrarenal arteries and the colon wall. Previous case reports showed that beta 2-microglobulin amyloid deposits in various visceral organs but less frequently in the atrial and/or the ventricular myocardium. In the present case, amyloids in the heart were present in the intramural coronary arteries causing myocardial ischemia and infarction, which was the immediate cause of death.
Texte intégral:
Disponible
Indice:
LILAS (Amériques)
Sujet Principal:
Épanchement pleural
/
Oedème pulmonaire
/
Dialyse rénale
/
Ischémie myocardique
/
Vaisseaux coronaires
/
Amyloïdose
Type d'étude:
Etude diagnostique
/
Facteurs de risque
Limites du sujet:
Adulte très âgé
/
Femelle
/
Humains
langue:
Anglais
Texte intégral:
Autops. Case Rep
Thème du journal:
Anatomia
/
Patologia Cl¡nica
/
Patologia Legal
Année:
2017
Type:
Article
Pays d'affiliation:
États-Unis d'Amérique
Institution/Pays d'affiliation:
Mayo Clinic/US
/
New York Medical College/US
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