(99m)Tc-HMDP scintigraphy rectifies wrong diagnosis of AL amyloidosis

Arnault Galat, Axel Van Der Gucht, Magali Colombat, David Attias, Emmanuel Itti, Michel Meignan, Fabien Lebras, Valérie Molinier-Frenkel, Nicole Benhaiem, Aziz Guellich, Jean Rosso, Thibaud Damy
Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology 2015, 22 (4): 853-7
A 71-year-old African man without history of cardiac disease was referred to our center for dyspnea. Transthoracic echocardiogram and cardiac MRI were suggestive of cardiac amyloidosis (CA). The diagnosis of the light-chain cardiac amyloidosis (AL-CA) was made after a first endomyocardial biopsy. Accordingly chemotherapy was started. Systematic 99mTc-HMDP scintigraphy showed moderate cardiac uptake (visual score of 2), unusual for AL-CA, and permitted to rectify the diagnosis. Hereditary transthyretin cardiac amyloidosis was confirmed by a second endomyocardial biopsy with a positive Congo-red and anti-transthyretin antibody stainings, mass spectrometry and genetic analysis (Val122Ile mutation).

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