ABSTRACT
Coronary artery bypass grafting resulted in a fatal outcome in two patients with unsuspected cardiac amyloidosis. Despite preoperative symptoms of myocardial ischemia, each case represented a different pathophysiological combination of cardiac amyloidosis and coronary artery disease. Pitfalls preventing correct diagnosis and possible patterns of treatment are discussed.
Subject(s)
Amyloidosis/complications , Amyloidosis/diagnosis , Coronary Stenosis/etiology , Coronary Stenosis/surgery , Internal Mammary-Coronary Artery Anastomosis/adverse effects , Aged , Amyloidosis/physiopathology , Cardiopulmonary Bypass , Coronary Circulation , Coronary Stenosis/physiopathology , Diagnostic Errors , Fatal Outcome , Humans , MaleABSTRACT
A 66-year-old woman, non-smoker, with a diffuse bilateral pulmonary interstitial involvement caused by multiple carcinoid tumorlets associated with a diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH). The process has developed during the last two years of the patient's life. There were no pathologic changes in the remnant pulmonary parenchyma. Moreover, the minute typical carcinoid (5.2 mm) was encountered after extensive pulmonary tissue examination. The spectrum of DIPNECH, multiple tumorlets, and typical carcinoid tumor demonstrates a possible neoplastic character of the pulmonary tumorlet.
