DOI:10.2214/AJR.05.0221
AJR 2006; 186:907-908
© American Roentgen Ray Society
Dialysis-Related Amyloidoma Presenting as a Bilateral Gluteal Mass
Martin Libicher1 and
Jürgen Freyschmidt2
1 University of Heidelberg Heidelberg 69120, Germany
2 Klinikum Bremen-Mitte Bremen 28205, Germany
A 63-year-old man presented with intermittent left-sided sciatica and a
bilateral swelling of the gluteal region. MRI was performed to exclude
infection and a soft-tissue tumor. The patient had end-stage renal disease and
had received dialysis for 29 years.
MRI showed a bilateral bulky mass at the proximal portion of the hamstring
muscles with a crescent-shaped fluid collection on the left side (Figs.
4A,
4B, and
4C). The mass was
heterogeneously hyper- and hypointense on both the T1-weighted spin-echo and
T2-weighted turbo spin-echo images. After contrast enhancement, the left-sided
mass appeared larger, with a diameter of 13 cm compared with 8 cm on the
contralateral side (Fig. 4C).
Intraarticular erosions of both hip joints involving the femoral head and
acetabulum were also observed.
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Fig. 4A —Bilateral amyloid pseudotumor in 63-year-old man with long-term
dialysis. Mass is located at proximal portion of hamstring muscles (white
arrows). Mass is heterogeneously hyper- and hypointense on both
T1-weighted spin-echo (A) and T2-weighted turbo spin-echo (B)
images. On gadolinium-enhanced T1-weighted spin-echo image with fat
suppression (C), crescent-shaped fluid collection (asterisks)
and contrast enhancement on symptomatic left side are more prominent than in
A and B.
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Fig. 4B —Bilateral amyloid pseudotumor in 63-year-old man with long-term
dialysis. Mass is located at proximal portion of hamstring muscles (white
arrows). Mass is heterogeneously hyper- and hypointense on both
T1-weighted spin-echo (A) and T2-weighted turbo spin-echo (B)
images. On gadolinium-enhanced T1-weighted spin-echo image with fat
suppression (C), crescent-shaped fluid collection (asterisks)
and contrast enhancement on symptomatic left side are more prominent than in
A and B.
|
|
View larger version (123K):
[in this window]
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Fig. 4C —Bilateral amyloid pseudotumor in 63-year-old man with long-term
dialysis. Mass is located at proximal portion of hamstring muscles (white
arrows). Mass is heterogeneously hyper- and hypointense on both
T1-weighted spin-echo (A) and T2-weighted turbo spin-echo (B)
images. On gadolinium-enhanced T1-weighted spin-echo image with fat
suppression (C), crescent-shaped fluid collection (asterisks)
and contrast enhancement on symptomatic left side are more prominent than in
A and B.
|
|
The bilateral and periarticular location was considered a characteristic
finding of dialysis-related amyloidosis, also referred to as
ß2-microglobulin associated amyloidosis
[1,
2]. Because MRI of the lumbar
spine was normal, we inferred that the symptoms were caused by the left-sided
mass compromising the sciatic nerve. Percutaneous biopsy confirmed the
diagnosis of ß2-microglobulin deposition. Oral therapy of
analgesics was administered with only temporal pain relief. Surgery was not
considered because of additional chronic heart failure.
ß2-microglobulin-associated amyloidosis of the
musculoskeletal system is well established in patients with long-term
hemodialysis. Periarticular amyloid deposition is typically observed
bilaterally in the shoulders, hips, knees, and wrists resulting in osteolytic
lesions that can be seen on radiographs
[3]. Amyloid shows low to
intermediate signal intensity on all pulse sequences. This finding may be
helpful in the differential diagnosis of synovial masses with hemosiderin
deposition [4]. There is one
report of popliteal amyloidomas developing after 26 years of dialysis
[5]. In our case, the time
interval was 29 years. Bilateral soft-tissue tumors should therefore be
considered as amyloidomas in patients with long-term hemodialysis.
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