Amyloid cardiomyopathy presenting as persistent symptomatic pleural effusions

A 73-year-old male presented with dyspnea and bilateral transudative pleural effusions that persisted despite aggressive diuresis. No etiology had been established despite an extensive workout. The only abnormal finding was diastolic dysfunction documented in an echocardiographic study. This raised the possibility of amyloid infiltrative cardiomyopathy. The diagnosis was supported by the findings of right cardiac catheterization and established by abdominal fat biopsy. The presence of systemic amyloidosis with myocardial infiltration should be ruled out in any patient with otherwise unexplained transudative pleural effusions and evidence of diastolic heart dysfunction. © 2005 Elsevier Ltd. All rights reserved