# Multimodality Imaging in Monoclonal Gammopathy of Undetermined Significance and ATTR Wild-Type Cardiac Amyloidosis

## TL;DR

This case report shows how combining blood tests and multiple imaging techniques helped diagnose a rare heart condition and a blood disorder in a patient.

## Contribution

The paper highlights the use of multimodality imaging for diagnosing cardiac amyloidosis in a patient with MGUS.

## Key findings

- Multimodality imaging confirmed wild-type transthyretin amyloidosis in a patient with MGUS.
- Technetium-99m pyrophosphate scan and bone marrow biopsy were key diagnostic tools.
- Early diagnosis allowed effective management with diuretics and symptom control.

## Abstract

Amyloidosis is characterized by the tissue deposition of insoluble fibrils derived from misfolded proteins. This case report describes a Hispanic man diagnosed with both monoclonal gammopathy of undetermined significance (MGUS) and wild-type transthyretin amyloidosis (ATTR) cardiac amyloidosis. The diagnosis was made using a combination of serological tests and multimodality cardiac imaging. The report highlights the importance of multimodality imaging in diagnosing cardiac amyloidosis, especially in cases where MGUS is also present. The patient presented with shortness of breath and was found to have cardiac abnormalities through electrocardiogram, echocardiogram, and cardiac magnetic resonance (CMR). A technetium-99m pyrophosphate (Tc-99m PYP) scan confirmed the presence of ATTR cardiac amyloidosis. Bone marrow biopsy confirmed MGUS. The patient was treated with diuretics and remained asymptomatic during follow-up. The report emphasizes the need for accurate diagnosis to differentiate between AL, ATTR, and MGUS due to their distinct clinical courses and treatments.